Resolving a simmering dispute, ousted Medicare plan agrees to pay
ALEXANDRIA, Va. The independent pharmacy lobby is hailing an agreement by Fox Insurance to begin paying overdue prescription coverage claims to the pharmacy benefit management firm administering its drug-coverage plan — and the retail pharmacies serving that plan.
Those claims have been frozen since Fox was ousted from the Medicare Part D prescription drug program in March over alleged policy violations. That marked the first time in the Part D program’s four-year history that the Centers for Medicare and Medicaid Services terminated a contract with a Part D drug plan, according to CMS and McKnight’s news service.
Fox’s subsequent decision to suspend claims payments while it worked to resolve its Medicare issues put a financial squeeze on both its PBM administrator — ProCare Pharmacy Benefit Management — and the community pharmacies that dispensed prescriptions to Medicare patients enrolled in the Fox plan. It also spawned a months-long campaign by the National Community Pharmacists Association to restore the payment pipeline.
Following bipartisan pressure applied by two powerful members of the Senate, the Centers for Medicare and Medicaid Services and the NCPA, the insurer agreed earlier this month to begin paying its delinquent Part D claims. Fox agreed July 9 to wire $13.6 million in overdue payments to ProCare, which is “currently closing claims and beginning to process payments for claims from the period of Feb. 16-28, 2010 in order to provide long-awaited reimbursements to independent community pharmacies for providing prescription drugs to seniors,” according to NCPA.
“Fox Insurance still owes tens of millions of dollars in unpaid Fox insurance claims from March, and is promising to clarify a few lingering issues to fulfill its remaining obligations,” the independent pharmacy group asserted today.
NCPA’s effort to resolve the issue kicked into high gear in May, when it sent a letter to CMS asking the agency to force the insurer to pay its delinquent claims. In response, the Medicare agency began applying pressure on Fox.
“However, it apparently took the interventions of the chairman and ranking member of the Senate Finance Committee, Sens. Max Baucus, D-Mont., and Charles Grassley, R-Iowa, who sent a letter on July 6 to prompt action from Fox Insurance,” noted NCPA.
“We want to thank Senators Max Baucus and Charles Grassley for their strong leadership in resolving the issue of the withholding of payments for rightful Medicare Part D prescription drug claims from independent community pharmacies that contracted with Fox Insurance,” NCPA’s acting executive vice president and CEO, Doug Hoey, said today. “Even though CMS terminated its Part D contract, Fox had a responsibility to honor these claims.
“We appreciate Fox Insurance’s recent efforts to set things right,” Hoey added. “It is a first step, but only a step, in solving the problem. We will be watching to make sure every penny owed is paid, and hope no Part D plan sponsors will require this amount of attention in the future.”
Novartis reports positive Q2
BASEL, Switzerland Sales and profits grew significantly for Swiss drug maker Novartis, with significant growth across divisions, according to the company’s second-quarter earnings report.
Novartis reported an 11% increase in net sales, to $11.7 billion, compared with $10.5 billion in second quarter 2009, while profits grew by 19%, to $2.4 billion, compared with $2 billion the year before.
The company’s major products mostly saw increases in sales; the cancer drug Gleevec (imatinib mesylate) had sales of $1 billion, compared with $990 million in second quarter 2009, while sales of the once-yearly osteoporosis treatment Reclast (zoledronic acid) increased from $115 million to $142 million.
Sandoz, the drug maker’s generics division, had an 11% sales increase, to $1.9 billion, compared with $1.7 billion in second quarter 2009.
Domann joining Kerr Health: Another sign of sweeping changes
WHAT IT MEANS AND WHY IT’S IMPORTANT Rounding out its Kerr Health management team, Kerr Drug has gone beyond its own deep bench of retail-oriented players.
(THE NEWS: Domann named Kerr Health’s VP sales and business. For the full story, click here)
For the past year, the company, which dominates drug store retailing in its home state of North Carolina, has been fine-tuning a new pharmacy-care business model aimed at employers and built on its solid foundation as a pharmacy and healthcare innovator. So it’s no surprise that Kerr turned to a highly experienced pharmaceutical industry veteran to head up sales and new-business efforts for the fast-growing health-services operation.
That choice is Dick Domann, an affable, 30-year drug industry veteran who forged a successful, 27-year drug-channel sales career with GlaxoSmithKline. As such, he’s forged close ties with retail pharmacy and is intimately familiar with its concerns, capabilities and potential as a patient-centered solution to America’s healthcare woes. As Kerr Health’s first VP sales and business, Domann brings a broad perspective in pharmaceutical marketing, managed care and government relations to Kerr, which is working to burnish its credibility with employer-based health plans in North Carolina and elsewhere.
Domann also is no stranger to Kerr’s operating region. Since 1987, he’s called North Carolina home –– GSK is based in the state’s famed Research Triangle district near Duke University, the University of North Carolina and other centers of learning and medical practice –– and he’s been active in local community, business and political organizations for many years. He’s also a fledgling novelist, having authored and published one novel, with another on the way.
Domann’s induction is another sign of the sweeping changes ongoing at Kerr, which has firmly established its bona fides as one of retail pharmacy’s best healthcare innovators. Kerr Health, the health-services division of Kerr Drug, encompasses a wide gamut of pharmacy-based patient services – including disease management, medication therapy management, employer-based inoculation and clinical-care services, long-term care and specialty pharmacy.
Much like Walgreens, Kerr is focused on expanding the range of clinical and pharmacy services it can provide to employer-sponsored health plans and managed care organizations. It bills its vision for patient health as “holistic” in terms of its view of the patient, and positions its services as an adjunct to the care provided by time-stressed physicians and community health centers.
“Kerr Health synergistically unites Kerr Health Care Services and KDI Health Solutions, two subsidiaries of Kerr Drug, Inc., one of the nation’s leading and most respected names in the chain drug industry,” the company notes in a description of its offerings. “Kerr Health provides a broad and customizable offering of value-driven products and services to medical practices, patients, employer groups, long-term care facilities, and municipalities.”