Changes proposed by the Centers for Medicare & Medicaid Services (CMS) could create turmoil for independent community pharmacies providing long-term care (LTC) services and especially for those pharmacies in underserved rural areas, the National Community Pharmacists Association’s (NCPA) LTC Division said in comments filed with CMS recently.

In response to inadequate data and the alleged wrongdoing by one national LTC pharmacy corporation, CMS has suggested requiring all LTC facilities to contract solely with consultant pharmacists who have no affiliations to any in-facility LTC pharmacy, pharmaceutical manufacturer, or drug wholesaler.

“If implemented as proposed, these requirements could compromise patient health,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “We look forward to working constructively with CMS and Congress to advance their goals in a more practical manner.”

In comments filed with the agency, NCPA made a number of points, including the following:

• CMS should gather more rigorous, empirical data before concluding that such disruptive regulatory mandates are warranted. In proposing its changes, CMS relied on insufficient data that, in many instances, cannot be broadly applied or has been rendered moot by subsequent industry developments.
• CMS should consider exempting three groups from the requirements. First, rural LTC facilities, which may not be able to find or afford the services of a consultant pharmacist who meets the proposed requirements; second, so-called “combo shops,” which serve both traditional out patient, or retail, customers as well as LTC residents, and therefore do not have access to the manufacturer rebate payments that concern CMS; and, third, privately owned, independent LTC pharmacies as they have not been associated with the drug-cost inflation and alleged activities that prompted CMS’ proposal. For example, one report found that, from 2004-2009, the average cost per prescription dispensed increased nearly 40% for corporate-owned LTC pharmacy providers whereas the comparable figure for independent, privately owned LTC pharmacies was just five percent.
• If it ultimately decides to implement such changes, CMS should delay the effective date past the proposed Jan. 1, 2013 date. The reason is because another significant regulatory requirement—that LTC pharmacies dispense certain high-cost drugs in shorter, 14-day (or less) cycles—is also set to take effect on that date, potentially creating a very difficult situation for LTC pharmacies and their patients.

A November 2011 survey of NCPA members supported the concerns expressed in NCPA’s comments. Namely, respondents indicated that 80% of the LTC facilities that they serve are in rural areas. Further, most pharmacists surveyed said that, in the communities that their LTC pharmacies serve, there is already a shortage of consultant pharmacists, which NCPA argues would become worse under CMS’ proposal. In addition, the overwhelming majority of respondents asserted that CMS’ proposed requirement would be detrimental to LTC facilities’ efficiencies, continuity of care, timeliness of care and services, and communication between health care providers.