PHARMACY

NACDS, NCPA urge CMS to ensure fair, accurate reimbursement for Medicaid drugs

BY Antoinette Alexander

ARLINGTON, Va. — With the expansion of Medicaid services in the Patient Protection and Affordable Care Act on the horizon, the National Association of Chain Drug Stores and National Community Pharmacists Association sent a letter to CMS urging the agency to take into consideration the true cost of dispensing prescription medications to Medicaid patients. 

In a letter to CMS, NACDS and NCPA stressed that to maintain patient access to pharmacies, CMS must ensure that states increase dispensing fees for Medicaid drugs in conjunction with the upcoming new Federal Upper Limits anticipated in 2014.  

CMS is currently in the process of determining new Medicaid FULs that would apply to pharmacy reimbursement for many common generic medications. NACDS and NCPA have repeatedly expressed concern about the reimbursement limits proposed to date by CMS because the associations believe that they would fail to cover even the pharmacy’s acquisition costs for hundreds of products.

In the letter, NACDS and NCPA emphasized that the average manufacturer price is an inaccurate benchmark for pharmacy reimbursement, and that there is no correlation between the weighted AMP and pharmacy acquisition costs.

“In a number of instances, the AMP-based FUL is lower than the pharmacy’s acquisition cost for a given drug,” the groups stated in the letter. “In light of the looming problem of under-reimbursement, it is important for CMS to advocate to State Medicaid directors the importance of increasing dispensing fees to account for this problem. We urge CMS to make clear to states that in order to maintain patient access to pharmacies, dispensing fees must be increased to reflect no less than the true cost of dispensing prescription medications to Medicaid patients.”

NACDS and NCPA also cite that if states do not increase their dispensing fees, Medicaid patient access to pharmacy may be at risk.

“If states fail to increase Medicaid dispensing fees at the same time that AMP-based reimbursement is falling, then pharmacies may be forced to withdraw from the Medicaid program, denying patients access to Medicaid drugs,” the groups stated in the letter. 

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APhA Foundation project uses collaborative care to target diabetes among vulnerable populations

BY Alaric DeArment

WASHINGTON — A project by the philanthropic wing of the American Pharmacists Association to include pharmacists on diabetes care teams in highly affected and underserved communities has produced significant decreases in blood-sugar levels among patients, according to results released Thursday.

The APhA Foundation announced the release of interim results of Project Impact: Diabetes, in which more than 2,000 patients in 25 communities who are uninsured, underinsured, homeless or living below the poverty line receive care from teams that include pharmacists, physicians, diabetes educators and other health professionals as part of a self-management program.

"The interim clinical results of Project Impact: Diabetes demonstrate that when pharmacists, physicians, diabetes educators and other members of the healthcare team work together, patients better manage their diabetes," APhA Foundation SVP research and innovation Benjamin Bluml said. Blum designed and leads the project.

Nearly 26 million Americans have diabetes, according to the American Diabetes Association, with 200,000 dying annually and millions more at risk of developing diabetes-related complications like heart disease and stroke, kidney failure, blindness and limb amputations. As with other health conditions, the most economically vulnerable patients also are the most vulnerable to the disease.

Under Project Impact: Diabetes, each community has a "champion" who works with an APhA Foundation community coordinator to customize implementation of the project and engage patients, healthcare professionals, payers and other local resources as they work to improve care. The foundation provides training and access to clinical data management tools and its Patient Self-Management Credential, which helps pharmacists identify each patient’s knowledge strengths and areas for improvement and allows providers to customize the education they provide to prioritize and address knowledge gaps.

Local care models include one-on-one consultations, educational classes, grocery store food tours, exercise programs, joint visits where pharmacists and physicians meet with patients together, and incentives like bus passes, grocery store gift cards, discounted or free healthy lunches at employee worksites and discounted co-payments for diabetes medications and supplies.

"The occurrence of diabetes is at epidemic proportions, and it has a devastating impact on our healthcare system, especially in communities where access to care may be limited," APhA Foundation executive director Mindy Smith said. "Through programs like Project Impact: Diabetes, the APhA Foundation is transforming healthcare delivery in local communities and driving fundamental change in the U.S. healthcare system."

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FDA approves subcutaneous Actemra for rheumatoid arthritis

BY Alaric DeArment

SOUTH SAN FRANCISCO, Calif. — The Food and Drug Administration has approved a new formulation of a drug made by Genentech for rheumatoid arthritis that can be injected into the skin.

Genentech announced the approval of a subcutaneous formulation of Actemra (tocilizumab) in adults for adults with moderate RA who have not found sufficient relief by taking such disease-modifying antirheumatic drugs as methotrexate. Like the intravenous formulation of Actemra, the new version can be used alone or with drugs like methotrexate.

"People with moderately to severely active rheumatoid arthritis can suffer irreversible joint damage that may be prevented by earlier treatment with a medicine such as Actemra," Genentech chief medical officer and head of global product development Hal Barron said. "We’re pleased that these patients will now have the option of Actemra as a subcutaneous injection or an IV infusion."

 

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