As published in Drug Topics
By: B. Douglas Hoey, RPh, MBA
Business acumen and clinical expertise are keys to successful community pharmacy ownership, but the federal government's reimbursements and regulatory policies are becoming more consequential with each passing year.
Later this year, the U.S. Supreme Court's ruling on the healthcare reform law will guide federal and state governments for years. Regardless of the outcome, the National Community Pharmacists Association (NCPA) will continue to work tirelessly with the government on behalf of community pharmacists and their patients in 2012 and beyond.
The biggest issue of 2011 became (and remains) the proposed merger of Express Scripts and Medco to form the nation's largest pharmacy benefit manager (PBM). Along with other groups, NCPA educated the U.S. Congress about the negative ramifications of the merger. In response, 2 U.S.-congressional subcommittee hearings were held at which community pharmacists were star witnesses. In addition, to date, 30 members of Congress have raised their concerns about the merger, which the Federal Trade Commission should reject.
Three critical bills were introduced in Congress with our support, and pharmacists should encourage their representatives to support the measures.
First, the Preserving Our Hometown Independent Pharmacies Act of 2011 (H.R. 1946) would enhance the ability of community pharmacies to negotiate with PBMs.
Second, the Pharmacy Competition and Consumer Choice Act (H.R. 1971/S. 1058) would increase PBM transparency to cut costs, limit abusive audit practices by PBMs while allowing reasonable oversight of pharmacies, and allow any willing, eligible pharmacy to participate in a plan's pharmacy network.
Third, the Medicare Access to Diabetes Supplies Act (H.R. 1936) would preserve seniors' ability to obtain diabetes testing supplies, and counseling on their proper use, at community pharmacies.
One important measure is now federal law: Repeal of a new, onerous 1099 tax reporting requirement that would have required community pharmacies, starting in 2012, to be forced to file as many as 200 additional 1099 forms per year.
In 2011, NCPA encouraged Sens. Jerry Moran (R-KS) and Jon Tester (D-MT) to found the first-ever Senate Community Pharmacy Caucus. In the House, Cathy McMorris Rodgers (R-WA) and Mike Ross (D-AR) re-established the Congressional Community Pharmacy Caucus. The caucuses host briefings for congressional staff and work to raise awareness of important issues for community pharmacies and their patients with fellow members of Congress.
Federal regulators in the Executive Branch are another matter altogether. After hearing from NCPA and others, Medicare agreed to delay for 1 year its long-term care "short-cycle" rule, which requires 14-day (or less) dispensing cycles. The agency also softened the regulation to be less onerous for community pharmacies when it takes effect in 2014.
The so-called 340B drug-discount program is now receiving more oversight and attention. More work remains, however, to ensure that this program focuses squarely on the truly needy.
Working with CMS
NCPA worked with the Centers for Medicare and Medicaid Services (CMS) to include and recognize the value of community pharmacy in improving coordination and cost-savings in the accountable care organization (ACO) model. Now, most pharmacies can contract with ACOs to provide services such as medication therapy management and vaccinations.
Also, after hearing from community pharmacy, CMS agreed to delay implementation of a provider-verification system, known as PECOS, until a smooth transition can be made. And the agency's expanded use of auditing contractors was modified to incorporate common sense protections for pharmacies against abusive audits.
There has been at least as much activity in state capitals around the country, so NCPA expanded its resources and attention to supporting pro-pharmacist, pro-patient state legislation. Most notably, New York state pharmacists helped enact an anti-mandatory mail-order law; a well-intentioned, but potentially disastrous drug diversion bill was averted in Florida; and transparency provisions or fair audit provisions were established in Arkansas, Kansas, Maryland, Mississippi, North Dakota, North Carolina, Oklahoma, Texas, and Utah.
This new year will again require our profession to react to harmful polices and to try to enact helpful policies. Pharmacy is inextricably linked to government actions, so we have to lead the charge for ensuring that partnership is mutually beneficial.
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