(Washington, DC)- The Pharmaceutical Care Management Association (PCMA) issued the following statement in response to a new analysis released by the Congressional Budget Office (CBO) that estimates the costs associated with sweeping antitrust exemptions for independent pharmacies:

“The new CBO analysis confirms that sweeping antitrust exemptions for independent pharmacies would increase costs for Medicare Part D, Medicaid, the Federal Employees Health Benefits (FEHB) program, and as well as for employers and consumers.  HR 971 would give independent pharmacies a ‘license to collude’ to raise prescription drug prices, without adding value for consumers or payors.

“CBO found that HR 971 would increase federal costs by $640 million over ten years and that increased drug costs to private health plans, employers, and consumers would result in ‘reductions in the scope or generosity of health insurance benefits, such as increased deductibles or higher copayments.’  CBO’s analysis also contends that cost increases resulting from the legislation would be passed along to workers, reducing ‘both their taxable compensation and other fringe benefits.’

“During testimony on HR 971 before the House Judiciary Committee Antitrust Task Force, the Federal Trade Commission (FTC) stated: ‘Giving heath care providers . . . a license to engage in price fixing and boycotts in order to extract higher payments from third-party payers would be a costly step backward, not forward, on the path to a better health care system.’   

“The FTC also stated ‘it also bears emphasis that there are a variety of lawful ways – short of price fixing and coercive boycotts – that pharmacies can collectively express their concerns about both price and quality issues relating to managed drug benefit programs.’

 “Independent pharmacies currently enjoy numerous collective bargaining tools to gain market power in government and commercial programs, including:

• Independent pharmacies often participate in joint purchasing groups that allow them to lower costs and compete more effectively.
• Both Medicare and private insurers require geographic pharmacy network access standards for their enrollees that already provide pharmacies-particularly rural pharmacies-extensive negotiating power with PBMs.
• All health care providers, including pharmacies, can form joint ventures with other pharmacies to provide quality and clinical services and negotiate the fees for those services.
• Pharmacies also have the ability to utilize the “messenger model” that allows for network providers to use a third party to convey to purchasers information obtained individually from the providers about the prices or price-related terms that the providers are willing to accept.” [1]

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D

 

 

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[1] “Statements of Antitrust Enforcement Policy in Health Care,” August 1996

http://www.usdoj.gov/atr/public/guidelines/0000.htm

Proposed DEA Rule Would Not Improve Adoption of E-Prescribing for Controlled Substances

(Washington, DC)- The proposed rule from the Justice Department’s Drug Enforcement Administration (DEA) on electronic prescribing (e-prescribing) for controlled substances cannot be effectively implemented and would not enhance adoption of the technology for these medications, the Pharmaceutical Care Management Association (PCMA) said today.

“While the proposed rule doesn’t affect a physician’s ability to prescribe everyday non-controlled prescription drugs, it would create unnecessary burdens and workflow issues for physicians and pharmacists regarding controlled substances,” said PCMA President & CEO Mark Merritt.

• Ensuring Generic Substitution. The proposed rule would not allow electronic prescriptions for controlled substances to be changed by a pharmacist, creating the potential to negatively affecttools that are used to manage the pharmacy benefit, such as generic substitution. PCMA recommends clarifying that pharmacists are allowed to change prescriptions according to State law and not be considered “altering the prescription during transmission.”
• Validating a Prescriber’s DEA Registration. PCMA believes requiring a pharmacy to check the DEA database to validate prescriber registration in real-time before dispensing a controlled substance is costly and ineffective. The DEA database is not updated in real-time, but instead on a weekly basis. The lack of real-time information may result in the rejection of scripts from prescribers not yet integrated into the database.
• Streamlining Prescriber Identity Verification. To eliminate unnecessary burdens, PCMA recommends that e-prescribing service providers be allowed to verify a prescriber’s identification in-person. The proposed rule would require prescribers to go in-person to verify their identity, valid medical license, and DEA authority to prescribe controlled substances to any of the following: a DEA registered hospital where the prescriber has privileges, state or professional license board, or state or local law enforcement authority.  E-prescribing service providers already offer the most streamlined manner in which a prescriber can verify their identity in-person and present a solution that does not require prescribers to leave their office to be verified.
• Reducing Prescriber Workflow. The proposed rule would require practitioners re-authenticate if their e-prescribing system remains idle for more than 2 minutes. This timeframe is unreasonable and does not recognize the workflow demands of medical practice. In the commercial world, such timeouts are normally in the 15 to 20 minute range. PCMA recommends that the time lapse for re-authentication be revised to 15 minutes.

Mr. Merritt added: “Today, physicians electronically prescribe millions of non-controlled prescriptions every year.  They should be able to prescribe controlled substances electronically, too.”

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

PCMA Letter to the DEA on E-Prescribing for Controlled Substances

HHS and CMS Hosting National E-Prescribing Conference

3 Keys Points in Law Include Sufficient Reimbursements, Standards Consistent with Part D, and Securing Full Physician Adoption

 (Washington, DC)- With passage of the historic new law requiring electronic prescribing (e-prescribing) in Medicare, the Pharmaceutical Care Management Association (PCMA) today applauded the Administration’s continued leadership to ensure broad physician adoption of e-prescribing in Medicare. 

As part of this effort, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are hosting a groundbreaking conference October 6 – 7, 2008 at the Sheraton Boston Hotel, Boston, MA that is designed to educate and promote adoption of e-prescribing technology. 

“Everyone realizes that there are three keys in the current law that will rapidly accelerate physician adoption of e-prescribing,” said PCMA President and CEO Mark Merritt.  “These include: sufficient reimbursements for physicians; standards consistent with Part D; and securing full adoption by all eligible physicians.”

E-prescribing is successfully being used by more than 35,000 doctors nationwide.  In driving passage of the legislation, PCMA led a diverse group of consumers, employers, unions, and medical professionals that supported e-prescribing in Medicare. Supporters included among others: AARP, AFL-CIO, Consumers Union, Ford Motor Company, General Motors Corporation, and AT&T.

 

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.