U.S. Reps. Carter, Collins ask CMS to protect community pharmacies
WASHINGTON — U.S. Reps. Doug Collins and Buddy Carter sent a letter to the Center for Medicare and Medicaid Services on Wednesday asking for a review of Humana’s proposed amendments to its Pharmacy Provider Agreement for the 2017 Part D plan year.
The letter says the amendments will force independent community pharmacies to accept predatory pricing provisions that could severely impact their ability to do business. Collins and Carter, who have been strong advocates for community pharmacies, issued the following statements after sending the letter:
“In many rural parts of the country, including Northeast Georgia, folks may see their pharmacist more often than they see their doctor,” said Congressman Collins. Pharmacists, especially those from independent pharmacies, have an established connection with those they serve in the community, and take great care when advising their patients. Many of these establishments are family-run and have been part of these communities for years.”
“Humana, one of the largest insurance providers in the country, currently has a proposal the would require these small pharmacies to lose $5.00 per prescription, up front, with the hope that they will be reimbursed if they meet certain metrics. However, meeting all of the criteria is not a guarantee that the pharmacy will get reimbursed because there are only spots in the top rankings for a few pharmacies. Under this proposal, a pharmacy could meet most of the CMS benchmarks, provide quality customer care, and still not be reimbursed by Humana. Humana’s criteria has little to do with patient care, and everything to do increasing their profit and driving community pharmacies out of the market. Some of these metrics, including “patient adherence” are beyond the control of the pharmacists. Pharmacies already compete for customers and business, let’s not set a precedent to make them compete for reimbursement by insurance companies as well.”
“Humana is using this proposal to attempt to drive community pharmacies out of the marketplace, to clear the way for big box chain pharmacies like Walgreens and CVS. If this proposal is allowed by CMS and enacted, these community pharmacies will either have to pay huge sums of money with no guarantee they will be able to recover their costs, or become out of network providers, which will increase costs and drive patients away. Improper metrics are being used to determine the future existence of community pharmacies in this situation, and deserve further examination from CMS.”
“As a community pharmacist for more than 30 years, I know firsthand how hard it is for the smaller guys to stay competitive, especially in the face of predatory pricing,” said Congressman Carter. It is unsustainable and unacceptable for one of the largest insurance providers in the country to force small pharmacies to lose money upfront with an uncertainty on whether or not they will even be reimbursed. This proposal would allow Humana to not reimburse pharmacies even if they meet most of the CMS benchmarks.
“I’m a free-market guy. We need to let the free-market work. This proposal does nothing more than infringe on the free-market in pharmacy, increase Humana’s profits and actively work to drive community pharmacies out of the market. If allowed, this proposal will leave community pharmacists with two choices: leave themselves vulnerable to the very real possibility they will not be reimbursed or become an out of network provider which will increase costs for patients. My patients were always like family members and they should have the ability to choose whatever pharmacy is best for them and their health. I strongly urge Acting CMS Administrator Slavitt to reconsider this adverse proposal.”
Sanofi, Boehringer Ingelheim agree to asset swap
PARIS and INGELHEIM, Germany — Sanofi and Boehringer Ingelheim have agreed to a $25.1 billion asset swap, in which Sanofi will trade its Merial animal-health business for Boehringer’s consumer-health operation.
The agreement marks a major milestone before closing of the transaction, which is expected by year end and remains subject to approval by all regulatory authorities in different territories. The integration of Boehringer Ingelheim’s Consumer Healthcare business into Sanofi and Merial into Boehringer Ingelheim would start after closing.
“This is a win for Boehringer Ingelheim and Sanofi alike. Moreover, it is one of the most significant steps in our corporate history," said Andreas Barner, chairman of the board of Boehringer Ingelheim. "It demonstrates the consistent orientation of our business towards innovation-driven sectors. As a research based pharmaceutical company, we will substantially enhance our position in the future market for Animal Health and will prospectively be one of the largest global players in this segment. The similarity in culture and approaches of BI and Sanofi will ensure that the businesses acquired by the other partner will develop well in the future.”
The swap lays the foundation for both companies to reach size and scale in two highly attractive pharmaceutical activities. Combining Merial and Boehringer Ingelheim’s complementary portfolios and technology platforms in anti-parasitics, vaccines and pharmaceutical specialties would put the combined company into a more competitive position in the key growth segments of the industry and bring more value and innovation to customers globally.
AMCP launches biosimilars resource center online
ALEXANDRIA, Va. — The Academy of Managed Care Pharmacy is launching a new resource for pharmacists, physicians, nurses and other health care providers.
The Biosimilars Resource Center is a policy-neutral repository of educational resources and information on biosimilars that was developed in partnership with leading national pharmacy organizations and can be accessed at biosimilarsresourcecenter.org.
"Biosimilars are new to the U.S. market, and many health care professionals are still unfamiliar with their potential to improve patient care and lower costs," says AMCP CEO Susan A. Cantrell, RPh, CAE. "We understand that providers will have many questions about biosimilars, so we are committed to making BRC a comprehensive, one-stop resource for unbiased, up-to-date information on these products."
The BRC website will provide a comprehensive range of educational and resource materials aimed at pharmacists, physicians and other providers, including frequently asked questions, whitepapers, web-based educational seminars, continuing education programs and journal articles. The site will be continually updated as the latest information, laws and regulations become available.
Biosimilars are less expensive versions of originator biological therapies that have made remarkable progress in treating debilitating diseases such as cancer and rheumatoid arthritis. Biosimilars have been available in Europe for more than 10 years and only recently introduced in the U.S. market.
"Our initiative to educate U.S. health care providers about the benefits of biosimilars will be critical in ensuring that the therapies become widely adopted and utilized in a safe and effective manner," Cantrell says. "AMCP is proud to take the lead in this effort."