NACDS testifies on impact of rules governing Medicare, Medicaid payments
ALEXANDRIA, Va. Looming cuts in Medicaid prescription reimbursements will fail to cover the cost of business for many community pharmacies and could threaten patients’ access to medications, a pharmacy executive testified today before a congressional panel.
Appearing on behalf of the National Association of Chain Drug Stores, H-E-B Grocery Co. executive Dennis Wiesner told the U.S. House Committee on Small Business, Subcommittee on Regulations, Health Care and Trade that federal policies on Medicare and Medicaid pose major challenges for the nation’s pharmacy retailers.
Wiesner, senior director of privacy, regulatory, government and industry affairs and pharmacy managed care for the Texas-based supermarket chain, was one of several experts to testify at the hearing. The panel’s intent today: to examine the impact of regulations and programs from the U.S. Centers for Medicare and Medicaid Services on small health care providers.
Wiesner said NACDS’ roughly 200 member chains are “deeply concerned” about three areas of federal policy. Among them:
- The impact of “unfair Medicaid cuts” for pharmacy services;
- “Program inefficiencies and unfair treatment of retail pharmacy” under the Medicare Part D drug benefit program;
- Threats posed by increasingly difficult requirements for retailers wishing to participate in the Medicare Part B program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies, including new mandates that will require retailers to engage in competitive bidding in order to sell those products under Medicare. These regulations, said Wiesner, are likely to reduce the number of available providers and hamper seniors’ access to vital medical supplies—including diabetic testing kits.
Wiesner called particular attention to the change in Medicaid reimbursements as a result of budget cuts imposed by the Deficit Reduction Act. Efforts by CMS to shift Medicaid payments for generic drugs to a new federal upper limit based on the lowest reported average manufacturer price mark “a significant change” in the way those payments are calculated, he told lawmakers. The result, he added, would be to significantly underpay retailers for dispensing those drugs under Medicaid.
“The DRA cuts to Medicaid reimbursement, and the final rule to implement those cuts, place many retail pharmacies at risk of being forced to eliminate service to Medicaid recipients or close altogether,” Wiesner asserted. Many pharmacies, he testified, “will not survive the AMP cuts due to payments lower than their purchase price for generic drugs.”
Indeed, as many as 20 percent of all U.S. pharmacies could be forced out of business by the cuts, the pharmacy leader warned.
Wiesner also raised alarms about the Part D benefit program, which he said “is still plagued by some design and administrative problems that often create access difficulties for beneficiaries.” Those problems, he said, include unnecessarily long lag times between enrollment and eligibility, lack of access to extended supplies of medicines and “inadequate disclosure of terms for reimbursement” from the prescription drug plans administering Part D benefits.
Sanofi-Aventis, Debiopharm sue W.C. Heraeus over Eloxatin patent
BRIDGEWATER, N.J. Sanofi-Aventis and Debiopharm have filed a lawsuit in the U.S. District Court for the District of New Jersey against W.C. Heraeus, in which they accuse the company of helping generic drug makers infringe a patent on their active ingredient for the colorectal cancer drug Eloxatin.
In the suit, the plaintiffs claim that Heraeus manufactured the active pharmaceutical ingredient in Eloxatin for Mayne Pharma, Sandoz and Ebewe Pharma. The three companies independently submitted applications to sell generic versions of the drug before the 2013 expiration of the ‘874 patent.
Sanofi and Debiopharm have asked the court to issue a permanent injunction restraining Heraeus and its officers from selling and importing generic oxaliplatin products claimed in the patent into the U.S.
Currently, there are no FDA-approved generic versions of the drug, which had worldwide sales of $2.35 billion in 2007, according to Sanofi.
FutureScripts launches new Web site
PHILADELPHIA FutureScripts, a pharmacy benefit manager in Philadelphia, has unveiled a new website, www.futurescripts.com. The website is a tool for plan participants, health care professionals and benefit managers to help find key information about the drugs on FutureScripts’ formulary, how safe prescribing procedures work and much more.
“The new website allows our customers to find vital information about their medications—whether a drug is available as a generic and what that drug costs compared to similar medications,” said Paul Urick, senior vice president of FutureScripts. “Our website also provides health care professionals and plan participants the latest updates on the drugs on our formulary.”
Through the site, plan participants can find a participating pharmacy within the FutureScripts’ national network of more than 60,000 retail and specialty locations by ZIP code search or by entering a pharmacy name benefit managers can read about the latest pharmacy trends through the online FutureScripts InSight newsletter. The frequently asked questions section features the most common inquiries received by FutureScripts, ranging from ‘What is a 96-hour temporary supply?’ to ‘How do I request an exception to an age, gender, or quantity limit?’
“Overall, our new site was designed to service the needs of our customers and was developed in response to their suggestions,” said Urick. “We expect to further enhance and customize our website to fit the evolving needs of plan participants, employers, health care providers, and pharmacists.”