NCPA offers lawmakers updated health care reform recommendations
January 14, 2016
Reform the Medicaid Average Manufacturer Price (AMP) reimbursement system for generic drugs and adopt, at a minimum, the Senate's federal upper limit of no less than 175% of the weighted average AMP. Anything less could force many independent community pharmacies, which care for an extraordinarily high number of Medicaid patients, out of the programbine House-passed transparency provisions for pharmacy benefit managers (PBMs) operating in the proposed health insurance exchange with Senate language extending the reporting requirements to Medicare Part D drug plans. A broad coalition of consumer and labor advocates also support PBM transparency to root out wasteful spending.Assure seniors access to essential durable medical equipment (DME) by adopting the Senate's proposal to exempt from Medicare's burdensome, duplicative accreditation requirements those pharmacies that derive no more than five percent of total prescription sales from DME, such as diabetes testing supplies.Support all House and Senate-passed provisions expanding the community pharmacist's ability to provide medication therapy management services to maximize the patient's adherence and therapeutic benefit while lowering the cost of inappropriate prescription drug use -- estimated at $290 billion annually.
NCPA's letter also raises questions about how a new, government-sponsored "public option" would impact independent pharmacies, both in terms of reimbursement as well as small business health insurance requirements; suggests alternatives to a costly proposed mandate under Medicare; cautions against any federal pre-emption of state-based "any willing provider" laws; opposes moving Medicare vaccination coverage into the Part B program; backs safeguards to prevent 340B, low-income drug subsidies from being diverted to hospital employees and others; seeks clarification that any provision allowing the government to set Medicare drug prices not apply to pharmacy reimbursement; and supports House-passed language to close the Medicare Part D coverage gap, or "donut hole."
SOURCE National Community Pharmacists Association