Coalition Wins Victories in Congress

DECEMBER 01, 2008
Julie Khani and Charles Sewell

Ms. Khani and Mr. Sewell are copresidents of the Coalition for Community Pharmacy Action.

As the 110th Congress winds down, the Coalition for Community Pharmacy Action (CCPA) wishes to thank you for your help in achieving significant victories in 3 major areas this year—delay of pharmacy reimbursement cuts for generic drugs in Medicaid, prompt payment in Medicare Part D, and preservation of pharmacy choice for TRICARE beneficiaries.

Julie Khani
Vice president
of federal
programs at

Charles Sewell
Senior vice
of government
affairs at

Over President Bush's veto, Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which included several provisions critical to community pharmacy. First, MIPPA delayed cuts in Medicaid pharmacy reimbursement for generic drugs until September 2009. The Deficit Reduction Act of 2005 applied the use of Average Manufacturer Price (AMP) in calculating federal payment limits to pharmacies in the Medicaid program. The use of AMP was expected to reduce pharmacy reimbursement below the cost to acquire medications and result in the closure of as many as 11,000 pharmacies nationwide. This delay, while a short-term solution, is critically important because it allows community pharmacy additional time to advocate for a permanent legislative fix to AMP.

Second, MIPPA included an important requirement that, starting in 2010, plans must pay pharmacies within 14 days after receipt of clean claims submitted electronically and 30 days for clean claims submitted by other means. This provision, long advocated by the CCPA, will end needless delays in payment to pharmacies, help many pharmacies that have struggled to remain in business, and allow pharmacists to focus on patient care.

In addition to the provisions contained in MIPPA, community pharmacy achieved a significant victory when Congress approved S 3001, the National Defense Authorization Act for Fiscal Year 2009. This legislation extends for 1 year the current freeze on retail pharmacy copayments for TRICARE beneficiaries, ensuring that 9 million active-duty military personnel, retirees, and their families will not face cost increases for obtaining prescription drugs and services from retail pharmacies.

Community pharmacy has worked tirelessly to freeze TRICARE retail pharmacy copayments at current levels in order to prevent efforts to drive beneficiaries to mail order. The CCPA strongly believes that the choice of where to obtain prescription medications should be left to TRICARE beneficiaries.

While the CCPA—in conjunction with the National Community Pharmacists Association and the National Association of Chain Drug Stores—made large strides in Congress this year, it is vital that we continue to educate lawmakers in the next Congress on the importance of community pharmacies and those they serve.