The Details:
An interesting angle to NCPA's push for The Medicare Access to Diabetes Act.
Market analysis is seeming to show that Wal-Mart is using its low cost prescriptions, to the point of losing money per prescription filled, as a means to get customers in the door, only to increase the costs on other items (here diabetes supplies) to make up the difference.
My Feelings:
There are many angles of consideration here, and one of these days I will try to exhaustively list my feelings on the issue. In short: I am in NCPA because I feel independent business is vitally important to a thriving economy, and Wal-Mart has caused many independent businesses to go out of business. Yet, it is not Wal-Mart that does that, since it is the customers who opt to go to Wal-Mart who do so. In economic terms Wal-Mart has operated efficiently, and should be respected for such. My supreme concern is that the economic playing field be balanced and open. If one business is allowed to muscle its way through because of its size, and because it can sustain a larger game of attrition or it can get away with questionable practices, then the customer/patient suffers.
Sunday, June 26, 2011
Vermont Pharmaceutical Information Ruling by Supreme Court
The Details:
The U.S. Supreme Court made a ruling on Thursday (June 23) on a case of pharmaceutical information in Vermont.
The case involved the sale of prescribing information (only what doctor prescribed what drug, not to whom) from pharmacies to "data miners," who would in turn compile the information and sell it back to pharmaceutical manufacturers, who would in turn use the information to fine tune their marketing strategies to doctors.
Vermont law made the above practice illegal, but allowed the sale of prescribing information for other non-marketing reasons, such as health research.
The Supreme Court ruled that the Vermont law was invalid since it unconstitutionally burdened the pharmaceutical manufacturer's free speech, i.e. marketing, in comparison to the other entities who had access to the information.
My Feelings:
This is a tough one in my opinion. If the law allows one entity to receive the information, but bans another, it is by definition unfair and discriminatory. But, at what point does that unfairness or discrimination become unconstitutional?
What I find most interesting, and maybe slightly disturbing, is that the acquisition of information is considered part of free speech. Creation and dissemination, yes, but acquisition?
The U.S. Supreme Court made a ruling on Thursday (June 23) on a case of pharmaceutical information in Vermont.
The case involved the sale of prescribing information (only what doctor prescribed what drug, not to whom) from pharmacies to "data miners," who would in turn compile the information and sell it back to pharmaceutical manufacturers, who would in turn use the information to fine tune their marketing strategies to doctors.
Vermont law made the above practice illegal, but allowed the sale of prescribing information for other non-marketing reasons, such as health research.
The Supreme Court ruled that the Vermont law was invalid since it unconstitutionally burdened the pharmaceutical manufacturer's free speech, i.e. marketing, in comparison to the other entities who had access to the information.
My Feelings:
This is a tough one in my opinion. If the law allows one entity to receive the information, but bans another, it is by definition unfair and discriminatory. But, at what point does that unfairness or discrimination become unconstitutional?
What I find most interesting, and maybe slightly disturbing, is that the acquisition of information is considered part of free speech. Creation and dissemination, yes, but acquisition?
Wednesday, June 15, 2011
Pharmacy Benefit Managers
For those interested in going into independent pharmacy, one will quickly hear about Pharmacy Benefit Managers, or PBM's. Essentially these are the insurance companies that go out and market an insurance plan to businesses or individuals in order to cover their perscriptions. They are also the entities that pharmacies need to work with and through in order to get reimbursements for drugs sold to individuals under the respective insurance plans.
One of NCPA's largest complaints, and I fundamentally believe rightfully so, is that PBMs do not act fairly. Two major reasons for this are their size and the lack of transparency to observe what they are doing. This sets up economic incentives for PBMs to perform questionable behavior, succumming to the market pressure to maximize bottom lines.
Here is a good summary of some of the issues and complaints that are against PBMs.
One of NCPA's largest complaints, and I fundamentally believe rightfully so, is that PBMs do not act fairly. Two major reasons for this are their size and the lack of transparency to observe what they are doing. This sets up economic incentives for PBMs to perform questionable behavior, succumming to the market pressure to maximize bottom lines.
Here is a good summary of some of the issues and complaints that are against PBMs.
NCPA Legislative Conference 2011 Summary
NCPA had its 2011 Legislative Conference in Washington D.C. The major pieces of legislation that were pushed were:
1) A push for congress men and women to join the pharmacy caucus. This would demonstrate that the member of congress is publicly saying they are concerned about the issues of pharmacy.
2) The Pharmacy Competition and Consumer Choice Act. House Version: HR 1971, Senate Version: S 1058. These bills aim to make Pharmacy Benefit Managers (PBMs) more transparent. To understand more about PBMs read here.
3) The Medicare Access to Diabetes Supplies Act. House Version: HR 1936. In order to try to lower government spending, the Centers for Medicare and Medicaid Services (CMS) feel that having diabetic supplies covered under Medicare Part D being sold only through those who can bid the lowest price would reduce overall spending. What this means is whoever could offer the lowest Diabetes supplies reimbursement, would get sole Medicare Part D funding to cover the sales. This would mean that only large chain organizations could offer Medicare Part D covered Diabetes supplies without 1) charging patient full market price or 2) selling Diabetes supplies at a business loss. Essentially bottom line cost reduction will reduce availability, which would especially hurt rural areas and independent pharmacies.
4) The Medication Therapy Management (MTM) Benefits Act of 2011. House Version: HR 891. This bill seeks to lower the requirements (conditions and number of drugs) a patient must have in order to have MTMs covered under Medicare Part D. This is to increase the pharmacist's role in MTMs, by allowing more reimbursements for time spend doing MTMs to more patients.
1) A push for congress men and women to join the pharmacy caucus. This would demonstrate that the member of congress is publicly saying they are concerned about the issues of pharmacy.
2) The Pharmacy Competition and Consumer Choice Act. House Version: HR 1971, Senate Version: S 1058. These bills aim to make Pharmacy Benefit Managers (PBMs) more transparent. To understand more about PBMs read here.
3) The Medicare Access to Diabetes Supplies Act. House Version: HR 1936. In order to try to lower government spending, the Centers for Medicare and Medicaid Services (CMS) feel that having diabetic supplies covered under Medicare Part D being sold only through those who can bid the lowest price would reduce overall spending. What this means is whoever could offer the lowest Diabetes supplies reimbursement, would get sole Medicare Part D funding to cover the sales. This would mean that only large chain organizations could offer Medicare Part D covered Diabetes supplies without 1) charging patient full market price or 2) selling Diabetes supplies at a business loss. Essentially bottom line cost reduction will reduce availability, which would especially hurt rural areas and independent pharmacies.
4) The Medication Therapy Management (MTM) Benefits Act of 2011. House Version: HR 891. This bill seeks to lower the requirements (conditions and number of drugs) a patient must have in order to have MTMs covered under Medicare Part D. This is to increase the pharmacist's role in MTMs, by allowing more reimbursements for time spend doing MTMs to more patients.
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