Presidential Candidates Press for Changes in Medicare Rx Plan

Pharmacy Times
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The Bush Administration program for prescription drug benefits for seniors promises to be a key issue in the 2004 election campaign. Every one of the Democratic contenders vowed to press for major changes in the new Medicare Rx drug plan if elected.

Sen John Kerry (D, Mass) pledged to add "real cost-containment" provisions to the Medicare drug plan, and to reward employers who offer prescription benefits to retirees.

Sen John Edwards said that the cost of drugs should be lower, "not just for seniors, but for all Americans." He also would push for legalized "reimportation" of drugs to reduce medication costs.

Other Democratic hopefuls, including Rep Dennis Kucinich (D, Ohio) and Rev Al Sharpton, proposed scrapping the current Medicare plan altogether in favor of a "single-payer" system under which the federal government would provide health coverage for all.

Still No Consensus on Pharmacy Technicians, APhA Says

Pharmacy leaders are urging the Accreditation Council for Pharmacy Education (ACPE) not to rush through new standards for the education and training of pharmacy technicians, arguing that there is still no agreement throughout the profession on this issue.

"We have heard a wide array of opinions and comments from individuals, as well as major employers of pharmacists and pharmacy technicians, and have experienced an obvious difficulty in reaching consensus on this issue that impacts pharmacy practice settings in much different ways," American Pharmacists Association (APhA) officials told the council.

"Considering the number of years it took the profession to reach consensus on a single entry-level degree, it is not surprising that a vision on the issues" associated with technicians is proving elusive, the group's officials said. APhA also cited "a great deal of uneasiness" among pharmacists "with what is being perceived as a 'rush' to complete" ACPE's ongoing "dialogue" over pharmacy technician standards and accreditation.

Maine Considers No-Rx "Emergency-Contraception" Bill

Pharmacists in Maine soon may be authorized to dispense so-called "morning-after" emergency-contraceptive drugs without a doctor's prescription, under legislation proposed by state lawmakers. Under the proposal, specially trained pharmacists would be authorized to prescribe and dispense postcoital contraceptives to women who cannot get to a doctor in time for a prescription or who do not have a doctor because of lack of insurance.

If the legislature enacts the bill, Maine would join 5 other states that have already approved OTC distribution of morning-after contraceptive drugs. Although the Maine Pharmacists Association has taken no formal position on the bill, many pharmacists in the state support the measure because it would effectively expand their scope of practice by granting them limited prescribing powers.

Third-Party Pharmacy Reimbursement Plunges, Study Finds

Although prescription-drug spending has been climbing rapidly in recent years, pharmacy reimbursement levels are falling, according to a new study by the Pharmacy Benefit Management Institute (PBMI).

In 2002, the average dispensing fee paid to community pharmacies fell to $2.13, down from $2.50 in 1995. During that same 7-year period, product cost reimbursement also shriveled from 88.2% of average wholesale price (AWP) to just 85.9%.

Third-party reimbursement for mailorder drugs dropped even more sharply, according to the results of the study. The average dispensing fee paid to mailorder pharmacies declined from $1.82 in 1995 to $0.85 in 2002, while product cost reimbursement slipped from an average of 85% of AWP to 80.3%, the PBMI found.

According to the institute, much of the decline in pharmacy reimbursement levels is due to pressure from pharmacy benefit managers (PBMs). "PBMs work diligently to negotiate the best pharmacy reimbursement contracts for their customers," the PBMI said. Yet, "unlike in the past when the goal was simply to wring deeper discounts from the pharmacies, PBMs are now negotiating pharmacy contracts more strategically" to encourage more generic-product selection by pharmacists.

"As PBMs have increased generic drug reimbursement, pharmacies have begun to accept deeper discounts for brand drug reimbursement," the researchers said. "If pharmacies are able to make sufficient profit on generic drugs, they are better able to discount brand drugs."

Florida Medicaid Rx Fraud Triggers Crackdown

Officials in Florida have launched an aggressive new crackdown against fraud and abuse in the state's Medicaid prescription- drug program?a problem they blame on a small core of physicians and pharmacists who have been systematically defrauding the system.

One recent study found that under 3% of the state's medical professionals prescribed more than two thirds of the narcotics and other dangerous drugs dispensed to Medicaid patients.

The study also uncovered millions of dollars in suspect pharmacy billings for drugs, including claims paid using the billing numbers of doctors who were dead or ineligible to write prescriptions. In addition to costing taxpayers more than $346 million, the fraudulent activities have contributed to a rash of fatal overdoses by addicts who buy these narcotics on the street.

As part of the crackdown, officials are planning a new "early-warning system" to more quickly alert state officials to doctors, pharmacists, and patients who engage in Medicaid Rx fraud. Other plans include a computerized database that would track all narcotics prescriptions written in the state to discourage "doctor shopping"; new rules subjecting pharmacists to possible disciplinary action for dispensing practices that lead to drug overdoses; and criminal penalties for Medicaid patients who sell their prescription medications to others.

Drug Chains Call for High-Tech Attack on Rx Counterfeiting

The National Association of Chain Drug Stores (NACDS) has called on FDA officials to collaborate with the industry in a new effort to counteract prescription-drug counterfeiting. The chain proposal calls for a new uniform prescription-drug classification system that will categorize drugs according to counterfeiting risk and patientsafety criteria.

In addition, the NACDS has urged the FDA to cooperate in the launch of a "comprehensive anti-counterfeiting education and awareness campaign," to develop a centralized drug-counterfeiting alert and communication system. The association has asked the FDA to work with state boards of pharmacy and other governmental agencies to enforce existing importation laws and to educate consumers and lawmakers about "the safety risks and illegality associated with drug importation."

For its part, the industry should develop and implement a "technologyenabled track and trace system" to identify sources of counterfeit drugs, promote the use of new packaging to thwart counterfeiters, and create model "best practices" for drug purchasing that make it more difficult for counterfeits to enter the supply chain.

Audit Reveals Misaligned PBM Priorities

Misaligned pharmacy benefit manager (PBM) priorities are responsible for driving pharmacy costs up, confirmed a drug utilization audit conducted by AmeriPharm Pharmacy Services. The audit looked at client drug utilization data from nationally recognized PBMs. For example, payers such as managed care organizations and employer groups are seeking ways to contain drug prices and eliminate conflicting priorities. The top solutions include inhouse control of pharmacy functions and best-value drug utilization.

"The PBM generates revenue streams from misaligned formulary design, inappropriate drug switching, buy and bill practices, nonadherence to maximum allowable cost, markup of contracted services, and/or repackaging and repricing tactics," stated Ron Bertsch, RPh, president of AmeriPharm.

Clients and insurers began seeking alternatives in managing their prescription drug benefits following increasing litigation in 2003 against traditional PBM financial practices and their unwillingness to accept fiduciary responsibility. Industry experts have indicated that pharmacy payers are looking for self-management solutions to formulary design, rebate administration, and other pharmacy benefit services.

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