Rewarding health care’s unsung heroes


FORT LAUDERDALE, Fla. —Nurse practitioners are critical players in today’s healthcare system, and all too often these professionals are the “unsung heroes” of health care. In an effort to shine a well-deserved spotlight on their efforts and share their stories, this year’s Retail Clinician Education Congress once again featured Clinician Awards for Retail Excellence.

Taking home the CARE Lifetime Achievement Award (a.k.a., the Loretta Ford Award) was Susan Hassmiller, senior adviser for nursing/director of the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. Additional award winners included:

Unsung Hero Awards—Deb Paffenroth, Aurora QuickCare; Caroline Stein, Target Clinic; and Vicki Mitchell, The Little Clinic;

Lifesaver Awards—Jennifer Tucker, Minute-Clinic; Phyllis Smith, Take Care Health Systems; and Ann Maag, RediClinic;

Healthy Lifestyle Promotion Award—Ann Marie Coppen, Lindora;

Service Award—Angie Swatfager, MinuteClinic;

Leadership Award—Mike Ayotte, CVS Caremark/MinuteClinic; and

Academic Leadership Award—Patricia Starck, University of Texas School of Nursing

To salute the passage of Senate resolution 585, which created the National Convenient Care Clinic Week, Retail Clinician and the CCA presented Lt. Col. Corina Barrow of the Army Nurse Corps and currently the Nurse Corps Detailee for Sen. Dan Inouye, D-Hawaii, with a special CARE Champion Award. In addition, Pennsylvania Gov. Ed Rendell, who addressed RCEC attendees via a video feed shot from the governor’s office, was presented with a CARE Champion Award for the work he has done to advance the scope of practice of nurse practitioners in his state.

Tine Hansen-Turton, executive director of the CCA, presented a special joint CARE Leadership Award to CCA’s board of directors, including Andrew Sussman, president of MinuteClinic; Web Golinkin, president and CEO at RediClinic; Sandy Ryan, chief nurse practitioner officer at Take Care Health Systems; Janet Teske, manager, Aurora QuickCare; Ken Berndt, director of Bellin FastCare; and Cynthia Graff, president and CEO of Lindora.


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Sorry, FTC: ‘Pay-for-delay’ isn’t going away

BY Alaric DeArment

WHAT IT MEANS AND WHY IT’S IMPORTANT This week’s decision by the U.S. Second Circuit Court of Appeals could make political efforts to ban generic-branded patent settlements a lot more difficult.

(THE NEWS: Appeals court upholds decision to OK ‘pay-for-delay’ deals. For the full story, click here)

The Federal Trade Commission in particular, not to mention some members of Congress like Sen. Herb Kohl, D-Wis., has fought hard against so-called “pay-for-delay” settlements between branded and generic drug companies, contending that they delay patients’ access to generic drugs and cost consumers billions of dollars every year.

The concerns of opponents are understandable. Because generic and branded drug makers are supposed to be competitors, what seem on the surface like sweetheart deals must look positively Faustian to many people. But the judges in the appeals court affirmed that whatever their appearance, patent settlements don’t violate antitrust laws.

And the facts seem to support that decision. According to a report released in January by RBC Capital Markets, generic drug companies prevailed in 76% of cases that included settlements, but only in 48% of cases that went to trial. Meanwhile, according to a report released the same month by securities and investment banking firm Jefferies & Co., on average, patent settlements result in generic launch three years before patent expiration. Legally, a generic drug company must launch its version of a drug before or at the time of patent expiration.

While patent settlements often involve some type of monetary transaction, in many cases, the “pay” is in the form of a promise by the branded drug company not to launch an authorized generic, which is the branded drug sold under its generic name at a lower price. Under the Hatch-Waxman Act, the first generic drug maker to launch a knockoff of a branded drug is entitled to six months in which to compete directly with the branded version, but the authorized generic allows the branded drug maker to undercut the generic drug maker by marketing a supposedly “generic” version of its own.

Authorized generics have seen a bit of a pickup as well, and more activity on that front can be expected. On Tuesday, Greenstone, the generics arm of Pfizer, announced that it would create a new business called the Authorized Generics Alliance in order to market authorized generics under the Greenstone label.


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Medicaid plans to end onerous AMP rules

BY Jim Frederick


(THE NEWS: NACDS, NCPA in joint statement praise CMS’ move to withdraw provisions of AMP rule currently blocked by injunction. For the full story, click here)

The White House, or more specifically the Centers for Medicare and Medicaid Services’ division of Health and Human Services, announced in recent days that it plans at last to scrap its controversial and burdensome pricing policies for generic drugs bought by retail pharmacies to dispense to Medicaid patients. If CMS’ newly proposed rule goes through, it will mean the end of the current, much-disputed provisions that define the average manufacturer price of Medicaid me-too medicines.

The proposed rule, to quote the National Association of Chain Drug Stores, calls for “the withdrawal of existing provisions that define AMP, that determine the calculation of federal upper limits [FULs], and that define ‘multiple source drug.’”

As currently defined, Medicaid’s payment model for reimbursing pharmacists to dispense generics is based on a flawed formula for determining what retail pharmacies pay for those medicines, as determined by a set of controversial market metrics.

The current AMP policy almost is a guarantee that retail pharmacies would lose money on nearly every Medicaid generic prescription they dispense. It’s only a temporary court injunction that has thus far kept that new formula from being imposed.

Thus, CMS’ turnabout marks a real victory for the chain and independent pharmacy lobby, which has bitterly contested the AMP reimbursement formula since it was made policy by the Bush administration more than three years ago. But the plan to withdraw the current AMP model doesn’t end the long battle by pharmacy for a fair payment policy for dispensing generic drugs to Medicaid beneficiaries.

What the pharmacy industry –– and the U.S. healthcare system itself, for that matter –– need is a permanent solution to the Medicaid reimbursement mess. And that solution can only be achieved by congressional action and enactment of a new law governing Medicaid.

The 2010 health-reform law goes part way toward that solution, by holding the line on pharmacy cuts and setting the FULs on Medicaid prescription payments at no less than 175% of cost. It also includes what NACDS president and CEO Steve Anderson calls “a much-improved definition and calculation method for AMP” that will “better approximate pharmacies’ costs for purchasing generic drugs.”

Anderson said the injunction lawsuit filed in 2007 by NACDS and its independent pharmacy counterpart, the National Community Pharmacists Association, has saved pharmacy more than $5.3 billion in cuts since a federal court blocked the imposition of the new AMP formula in January 2008. It also may have prevented the closing of more than 11,000 community pharmacies that otherwise would have been forced to dispense Medicaid scripts at a loss or stop serving lower-income patients.

“When we filed the lawsuit in 2007, we knew that patient care was at stake,” Anderson asserted.

The bottom line is that the White House and Congress need to establish a federal payment system that rewards –– rather than penalizes –– pharmacies for dispensing lower-cost generics that provide the same safety and efficacy profiles as higher-cost pioneer medicines. Such a permanent fix would be a win both for the pharmacy industry and the American taxpayer, by saving tens or even hundreds of billions of dollars over the long term in federal health costs.


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