NCPA survey: Pharmacists speak out against ‘predatory audits’
ALEXANDRIA, Va. — A survey of 1,850 members of the National Community Pharmacists Association released Wednesday has identified two rising problems: 1) pharmacy audits often punish pharmacies severely for trivial issues and 2) because pharmacies are not privy to basic reimbursement methodology prior to signing contracts with health plans, reimbursements are "both lowered arbitrarily and raised belatedly in response to generic drug cost increases."
“Ostensibly, pharmacies are audited to guard against fraud, whereas payment caps are established to ensure appropriate reimbursement for generic drugs,” stated NCPA EVP and CEO Douglas Hoey. “However, this survey indicates that both have gone well beyond their intended purpose, while padding windfall PBM profits. Left unchecked, these practices will further undermine both the pharmacists’ ability to care for patients, as well as the viability of small business, community pharmacies and the local jobs and taxes they provide.”
Among the survey’s findings:
- Excessive audits are decreasing the time pharmacists can devote to patients. Illustrating the compliance burden, 62% considered the audit requirements to be completely inconsistent from one health plan to another; 48% of pharmacists reported auditors asking them to justify claims that are two years old or older; and, of the pharmacists who reported having appealed a PBM audit, 81% described that process as burdensome and unsatisfactory;
- 98% said PBM record-keeping requirements go beyond state and federal law, and that even minor, incidental instances of noncompliance are harshly penalized by commission-driven auditors;
- Community pharmacies must sign “blind,” take-it-or-leave-it contracts with large PBMs to maintain access to patients. Nearly all (91%) community pharmacists reported receiving little or no information justifying how PBMs arrive at reimbursement rates for generic drugs and how often the prices will be updated to reflect a pharmacy’s cost;
- 71% of pharmacists tried to use the PBM’s appeals process when they believed that the reimbursement caps, or MACs, did not reflect the pharmacy’s costs. Many pharmacists complained about the one-sided nature of the appeals process and noted that MAC-based reimbursement can take months to increase after drug costs spike (and is virtually never done retroactively), but is reduced immediately when prices go down; and
- When asked how PBM reimbursement and auditing practices affect pharmacists’ ability to provide patient care and remain in business, 97% said it was a significant or very significant factor.
Supplement trade requests NDI comment extension
WASHINGTON — Five trade associations representing the dietary supplement industry on Wednesday collectively requested a time extension to provide comments concerning the recent draft guidance on new dietary ingredient notifications that was recently issued by the Food and Drug Administration.
In the July 5 Federal Register notice, the FDA allowed for a 90-day public comment period. The trade associations are requesting an additional 45 days, which would extend the deadline to Nov. 17. "We applaud the FDA for the release of this document and welcome the opportunity to provide comments with respect to the draft guidance," the associations stated in its letter. "However, members of our respective organizations believe additional time is needed to adequately prepare meaningful feedback for the agency’s consideration."
The five trade associations include the American Herbal Products Association, the Consumer Healthcare Products Association, the Council for Responsible Nutrition, the Natural Products Association and the United Natural Products Alliance.
Topco institutes OTC substitution program for generic Rx
SKOKIE, Ill. — Topco, a member-owned cooperative serving the food industry, recently kicked off an initiative substituting its TopCare-branded over-the-counter medicines for the equivalent prescription pharmaceutical, where appropriate, in an effort to save patient dollars and promote the TopCare brand.
"We have developed a number of marketing tools to educate the pharmacists, retail employees and other member teams," Curt Maki, Topco VP health and beauty care/general merchandise program management and pharmacy, told Drug Store News. "We also have developed tools directly targeting consumers through various tactics and messaging, and will be working with our member stores to help them inform their customers on the program."
Specifically, where generic versions of recently switched medicines like Prilosec OTC are available without a prescription, participating supermarket pharmacists are able to substitute the equivalent TopCare product, omeprazole in this case, in place of a prescription heartburn remedy like Nexium. Depending on the prescription drug insurance plan, the co-pay for an OTC equivalent could total less than the co-pay associated with a generic prescription, Maki said. In other cases, the actual retail price of the TopCare brand could also be less than the generic prescription co-pay. "This program works very much like a generic prescription substitution," Maki said. "But instead the pharmacist switches the drug with a TopCare OTC product, and it is adjudicated through the pharmacy and health plan, accordingly."
Topco’s health and beauty care program specializes in procuring health, beauty and personal care products under the TopCare brand, which represent $300 million in annual retail sales. Participating grocers include Giant Eagle, Harris Teeter, Hy-Vee, Meijer, Wegmans, Weis and Winn Dixie.