PHARMACY

NACDS, NCPA renew challenge to Medicaid AMP payment plan

BY Jim Frederick

ALEXANDRIA, Va. The organizations representing chain and independent pharmacy have stepped up their legal challenge of a key element of the Bush Administration’s new payment plan for generic drugs dispensed under the Medicaid program.

At issue is how the government defines multiple-source drugs dispensed to Medicaid patients, and the impact that definition will have on reimbursement levels under the new Medicaid generic drug payment plan put forth by the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

In November 2007, the National Association of Chain Drug Stores and the National Community Pharmacists Association filed suit in United States District Court to block the rollout of that plan. Among their primary concerns: that the new payment formula for generics, based on the average manufacturer price [AMP] of the drug, would severely underestimate the real costs pharmacies incur for purchasing and dispensing generics to Medicaid patients. Pharmacy groups are also concerned that CMS’ definition of multi-source drugs is misleading, fails to comply with established law, and would further erode pharmacies’ operating margins.

“The primary legal flaw of the new final rule is that it does not comply with the definition of ‘multiple source drug’ established by the Social Security Act,” noted NACDS and NCPA in a statement. “The Social Security Act provides that a drug is not a multiple source drug in a state unless two or more equivalent drug products are ‘generally available to the public through retail pharmacies in that state.’

“Judge Lamberth has stated that the law on multiple source drugs is ‘crystal clear,’ but CMS continues to violate the state availability requirement,” the pharmacy groups added.

In their original lawsuit, NACDS and NCPA successfully won a preliminary injunction against the plan’s adoption. In their amended complaint, filed today, the two pharmacy groups add new challenges to the final CMS rule, issued in October 2008, which revises the definition of multi-source drugs.

In a joint statement, NACDS president and chief executive officer Steven Anderson and NCPA executive vice president and chief executive officer Bruce Roberts laid out the reasons for the legal challenge. “The revised definition of multiple source drugs is ill-conceived and fails to comply with the law. Along with the original AMP rule, the revised definition puts America’s pharmacies at risk of improper and inadequate Medicaid reimbursements,” said Anderson and Roberts. “This latest lawsuit amendment continues our commitment to getting the formula right on AMP so pharmacists and their patients will not have to suffer.”

Meanwhile, they point out, Judge Lamberth’s original injunction against the AMP rule remains in effect. “Both NACDS and NCPA will continue to pursue all existing claims against the AMP rule,” they asserted.

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Women’s stress levels may be hit harder by economy, report says

BY Michael Johnsen

WASHINGTON Women may be more prone to stressing out over poor economic conditions, which could have an impact on their health, a report from the Society for Women’s Health Research revealed last week.

Citing a recent survey from the American Psychological Association called “Stress in America,” SWHR noted that women are expressing fear about the current financial situation more than men. Women are also reporting physical and psychological symptoms, including sleep disturbances, headaches, mood swings and changes in appetite, in higher numbers than men.

Three quarters of male respondents to the APA survey expressed fear about the economy, compared to 84 percent of women.

“Women are sometimes more aware of the stress they are feeling,” Stephanie Smith, public education coordinator for the APA and a licensed clinical psychologist in Erie, Colo., said. “They are often more willing to talk about it and admit to the struggles they are having.”

Women also tend to be the primary caretakers for most families, which in times of economic crisis, can add to the burden. “Women have many roles to play in life. They are often the primary caregivers for children and the older generations [aging parents], as well as workers in industry,” Smith said. 

In addition, many of the traditional household responsibilities end up falling on the shoulders of women. “As much as things have changed over the years, women still tend to do more of the household work,” Smith said, referring to cooking, cleaning and laundry. “Taken together, these things often lead to more stress in women, because they just have more things to be stressed about.”

Women are more likely to report unhealthy behaviors, including eating poorly and excessive shopping and napping as a response to stress. They are also more likely than men to report physical symptoms of stress, including headaches, exhaustion and depression.

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SilverScript announces continuation of Medicare Rx drug plan options

BY Alaric DeArment

WOONSOCKET, R.I. A subsidiary of CVS Caremark announced Friday that it would continue offering several Medicare Prescription Drug Plan options next year in all 34 domestic Medicare regions and Puerto Rico.

SilverScript offers Medicare beneficiaries three plans, depending on patients? budgets and healthcare needs. They range from SilverScript Complete, a zero-deductible plan that covers generics through retail and mail-order pharmacies and copays as low as $6 for 90-day supplies, to SilverScript Value, a low-premium plan designed for beneficiaries who take few medications but want coverage in case their health needs change.

“Medicare beneficiaries will again have three SilverScript plan offerings to consider when selecting the prescription drug coverage plan that best fits their healthcare and medication needs,” CVS Caremark vice president for Medicare Part D services Jim Maritan said.

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