Jessica A. Smith Assistant Editor

As a vote on the final health care reform bill draws closer, 16 representatives and 9 senators are working to ensure that provisions for sufficient Medicaid reimbursement for generic drugs are included.

“Community pharmacies play a critical role as primary health care providers in all communities across the United States and often serve as the only resource to millions of lower income Americans for their daily needs,” a letter from the representatives to House Speaker Nancy Pelosi (D, CA) stated. “Failure to adequately fix the Medicaid pharmacy reimbursement would directly impact these patients and the pharmacies that continue to serve them.”

The bipartisan group of representatives is pushing for Pelosi (D, CA) to consider an increased federal upper limit for Medicaid reimbursement. Despite existing provisions in the House and Senate reform bills that reduce the major cuts written into statute, but held up by court injunction, the legislators wrote, they are not convinced that the proposed reimbursement would be enough to preserve access to pharmacies for Medicaid patients.

The 9 senators are urging Senate Majority Leader Harry Reid (D, NV) to ensure that a Medicaid reimbursement provision remains in the final version of the Senate health care reform bill. Pushing for the conference report of the bill to set Medicaid reimbursements at a minimum of 175% of the weighted average manufacturer price (AMP), the group of senators is made up of Democrats.

Both the National Association of Chain Drug Stores and the National Community Pharmacists Association (NCPA) lauded the efforts, while voicing their own feelings about the importance of fair reimbursement.

“Cuts to Medicaid generic prescription drug reimbursement based on the AMP would force the community pharmacy to lose, on average, at least 36% on every such prescription they fill,” said Bruce T. Roberts, RPh, NCPA president and chief executive officer. “That will cause many community pharmacies to limit their participation, drop out of the program, or even go out of business.”

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As a vote on the final health care reform bill draws nearer, 16 representatives and 9 senators are pushing for what they consider fair Medicaid reimbursement for generic drugs.

Federal Officials Push for Fair Medicaid Reimbursement

The unfortunate reality of being in the pharmacy business is that burglaries are bound to occur at some point. For one pharmacy in Memphis, Tennessee, the reality has hit hard. The Wiles-Smith Drug Store has endured 4 break-ins over the past 6 months. Store owner Charlie Smith, PharmD—battered, but not down for the count&mdash;does not want to give up on the 67-year-old landmark business, despite being understandably disheartened.

“I don’t know what I’d do if I wasn’t here. I really don’t,” Smith told reporters. “We’ve been here 67 years. I’d like to make it 70.”

For Smith, who runs the drugstore and soda fountain mostly on his own, the break-ins have been devastating not only because of the merchandise stolen, but also due to the costs of repairs and the extra work that comes with being burglarized. Filling out insurance paperwork, along with reporting to the Drug Enforcement Administration, the board of pharmacy, and the police department is time consuming and can be exhausting, Smith said.

The rash of break-ins at the drugstore started back in June, with the second burglary following soon after. Adding to Smith’s woes, his insurance company dropped him 3 months ago, leaving the pharmacist to bear the financial losses of the robberies. Worst of all is the fact that he also went unpaid for the other 2 burglaries, due to improperly filling out the paperwork.

Luckily for Smith, the burglars were not able to steal anything during the most recent break-in, because unlike in the other 3, the police nabbed the criminals this time. Law enforcement officials responded to an alarm after 1 of 3 individuals cut a hole in the pharmacy’s roof. 

Although there was no loss in merchandise, Smith is reeling from the other losses, along with those of the previous break-in, when the burglars broke through a brick wall in the establishment. 

Despite his multiple misfortunes, Smith is hanging in there, thanks to moral support from people in his community.

“Some people that didn't even know me, call me up say they saw it in the paper and they're so sorry to hear about it,” Smith told reporters. “It really touches you.”

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	Underlining the importance of the knowledge and guidance offered by pharmacists, the results of 2 surveys revealed that a large proportion of US adults are not clear on cough treatments. Although flu education has become a prevalent theme in light of the H1N1 outbreak, it appears that the information on symptoms and treatments may not have gotten through to many Americans, or at the very least, that clarification is needed for patients still unsure about how to treat their coughs, according to the results of the surveys, both conducted for the American Academy of Nurse Practitioners (AANP) by Harris Interactive.

	“We found patients are still confused about cold and flu symptoms and how best to treat them, even though there’s been a lot of education about the flu this year,” said Mary Ellen Roberts, RN, APN, MSN, MA, FAANP, nurse practitioner and AANP board member.

	The first survey, conducted in January—prior to the H1N1 outbreak&mdash;queried more than 500 nonsmokers aged 25 to 55 who reported having a cough due to cold or flu during the previous year. Results showed that 73% had experienced sleep disruption due to a cough during the past year&mdash;the symptom most commonly reported by cough sufferers, as well as the one most strongly associated with cough severity and likelihood of seeking professional treatment. Despite this, >two-thirds of those who did not stay home due to their cough reported doing so because they did not want to miss school or work.

	“Cough sufferers need to know that when they don’t get their symptoms treated rapidly and properly, they might not only lose effective rest, but there can be far-reaching ramifications on their work and school days,” said Roberts.

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The hype surrounding electronic health records (EHRs) has been palpable throughout the health care industry since President Obama announced his goal of implementing them for every American by 2014. Although the goal of large-scale EHR adoption is to streamline patient care, recent research published in 

(December 14, 2009) suggests that it can do quite the opposite in many cases.

	Researchers from the University College of London (UCL) based the study on findings from hundreds of existing studies on EHRs from around the world, finding “fundamental and often overlooked tension in the design and implementation of EHRs.”

	According to the study results, between 50- and 80% of electronic health record projects are unsuccessful; and the larger the project, the higher its likelihood of failure. The researchers found that smaller, more local EHR systems seem to provide greater efficiency and effectiveness than their larger counterparts.

	In addition, although secondary work can become more efficient with the help of EHRs, primary clinical work can become less efficient once EHRs have been implemented. The researchers pointed out that paper actually offers more of the needed flexibility for many areas of clinical work than what is provided by available EHR technology.

	Finally, the results showed that seamless integration of varying EHR systems is a near impossibility, due to the human input that will likely always be required.

	“Our results provide no simple solutions to the problem of failed electronic patient records projects, nor do they support an anti-technology policy of returning to paper,” said lead author and professor Trish Greenhalgh, of UCL’s Department of Open Learning. “Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world.”