PHARMACY

Survey: Home Infusion providers worry about impact of 21st Century Cures Act

BY David Salazar

AUSTIN, Texas — A new survey from Innovatix is highlighting concerns home infusion providers have as the 21st Cures Act enters its fifth month. Under the law, which was signed by President Barack Obama in December 2016, the payment structure for infusion drugs under Medicare Part B changed from an average wholesale price to an average sales price.

To compensate for this, the law includes a new Medicare payment for services that accompany home infusion treatments, but that doesn’t take effect until 2021, leaving 92% of home infusion providers surveyed saying they think the change to ASP will be damaging or severely damaging to their business. Thirty-one percent said the reimbursement change would likely push them to stop accepting new patients with Medicare benefits and 34% say they will be forced to discontinue home services for their existing patient population.

“As a result of the severe financial hardship imposed by the Cures Act, Medicare beneficiaries will find it much more difficult to access home infusion services, even though many of them prefer to receive care in the comfort of their own home, or are unable to travel to receive care,” Innovatix said in its results breakdown.

The survey found that 83% of respondents expected for the reimbursement shift to send patients to higher-cost facilities for their infusion, with Innovatix noting that it could be harmful to patient safety.

“Beneficiaries who are often susceptible to infection or other adverse clinical outcomes may now be forced to receive therapy in an institutional setting where they face greater risk of exposure,” the company said.

And beyond patient care, roughly 42% of respondents said they would be force to eliminate such jobs in their pharmacies as pharmacists and nurses, with 21% expecting job reductions of more than 21%.

“This policy change is having a devastating effect on home infusion providers, which many patients rely on to preserve their independence and quality of life,” Innovatix said. “Congress should act immediately to provide relief to pharmacies and ensure access to home infusion services for beneficiaries in 2018.”
 

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CVS CEO: Retailer will look at M&A opportunities that expand its suite of services

BY Brian Berk

NEW YORK — CVS Health has a “very strong balance sheet” and will “look into opportunities” in the merger and acquisition space that can help the retailer become even more helpful to its clients, president and CEO Larry Merlo said Wednesday during the UBS Healthcare Conference at the Grand Hyatt here.

“We want to be more impactful to the people we serve and continue to build up our portfolio of products,” he said, citing long-term care as among new areas CVS has moved into successfully in its goal to deliver the “last mile of care,” and its “ability to connect the dots across our suite of services.”

Merlo was joined by EVP and CFO Dave Denton at the event. The two CVS executives discussed a host of other topics, including improving the patient experience and making care more affordable and more accessible.

Among the other notes from both execs during the question-and-answer session were:

  • Healthcare literacy can be lacking in on the patient end, but CVS has the face-to-face interaction with customers every day to help improve this experience.
  • Transform Diabetes Care, a program intended to help the company’s pharmacy benefit management clients improve health outcomes of their members, lower pharmacy costs via aggressive trend management, and decrease medical costs by improving medication adherence, A1C control and lifestyle management, just launched early this year and has already been very successful.
  • Specialty pharmacy is another strong segment of CVS’ business. This strength can primarily be seen in CVS’ Specialty Connect is a specialty prescription services program offers patients choice and flexibility in how they access their specialty medications, while providing centralized, expert clinical support. Patients have the option to bring their specialty prescriptions to any CVS Pharmacy. After dropping off their prescription at the pharmacy, patients receive insurance guidance and dedicated clinical support by phone from a team of specialty pharmacy experts, trained in each therapeutic area, who are available 24 hours a day, 365 days a year.
  • Rebates are a “hot topic.” CVS confirmed that more than 90% of its rebate savings gets passed on to the customer.
  • Drug pricing is another important topic. At CVS, 87% of drugs dispensed are generic. CVS believes FDA commissioner Dr. Scott Gottlieb shares its view of a need to drive down drug costs.
  • The retailer is “quite pleased with what it has accomplished” in reference to the SilverScript prescription drug plan, which features zero deductibles and low premiums. It is attractive for customers, and earned an overall 4-star rating from the Centers for Medicare and Medicaid Services, the executives noted.

 

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Study: DIR fees, MACs are biggest concerns for rural pharmacists

BY Brian Berk

IOWA CITY, Iowa — Direct and indirect remuneration fees and delayed maximum allowable cost adjustment ranked highest on scales of both magnitude and immediacy for rural pharmacists, according to new research released by the RUPRI Center for Rural Health Policy Analysis.

Nearly 80% of respondents reported DIR fees as a very large magnitude challenge, with 83.3% reporting this as a very immediate challenge. Seventy-eight percent of respondents reported MACs not being updated quickly enough to reflect changes in wholesale drug costs as a very large magnitude challenge, with nearly 80% indicating it as a very immediate challenge.

Also of concern for rural pharmacists is Medicare Part D, with 58.8% of pharmacists reporting being an out-of-network pharmacy for Part D plans was a very large magnitude challenge (an additional 29.0% said large magnitude) and 60.5% said it was a very immediate challenge (an additional 28.1% said moderately immediate), according to the survey, titled “Issues Confronting Rural Pharmacies after a Decade of Medicare Part D.”

Pharmacy staffing, competition from pharmacy chains, and contracts for services for Medicaid patients were less likely to be reported as significant or immediate challenges.

Initial survey participation invitations were e-mailed on June 28, 2016, and follow-ups were sent on July 12, 2016. Responses were received from 118 pharmacies. RUPRI initially received email addresses for 430 independent retail pharmacies from the National Community Pharmacists Association.

NCPA issued the following statement following release of the research:

“The RUPRI Center’s study offers a much-needed exploration of the challenges facing small pharmacies that participate in Medicare Part D. The paper’s conclusions further validate our concerns about DIR fees, maximum allowable cost pricing transparency, and exclusion from ‘preferred pharmacy’ networks.

“Health care should not be dictated by where you live. However, in many rural areas independent community pharmacies are the sole health care providers for many patients. Unfortunately, the business practices of pharmacy benefit manager corporations make it harder for small pharmacy business owners to be profitable. 

“Nearly 80% of the surveyed pharmacies in the RUPRI study found both DIR fees and MAC reimbursements to be a significant challenge for their business, while almost 60% struggled with being out of network. Thankfully, there are legislative solutions pending before Congress that could bring relief on those issues. Health care professionals should urge Congress to pass the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, the Prescription Drug Price Transparency Act, and the Ensuring Seniors Access to Local Pharmacies Act of 2017) to help improve patient access to care.”
 

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