Monday, October 17, 2011

113th NCPA Annual Convention and Trade Exposition Update

The 113th Annual National Community Pharmacists Association Convention and Trade Exposition was phenomenal. It was an excellent mix of learning and fun, with plenty of both. If you did not get an opportunity to attend this year, please keep it in mind for next year when the 114th will be in San Diego, CA.

As always with these events there is a lot of information on the morphology of pharmacy in politics. So without further ado, let us get to the updates:

The Obama Administration's stance on PBMs
In President Obama's Plan for Economic Growth and Deficit Reduction, on page 41, the President starts indicating that drug deal programs (both PBMs and pharmaceutical manufacturers) need to be audited to make sure the government is getting the savings that they are supposed to be getting. On page 43, the President implies that using current PBMs is not a very efficient means of saving money, and suggests the government negotiate directly for coverage of employees. (Plan for Economic Growth and Deficit Reduction)

My thoughts: While this is not a "slam dunk" against PBMs, it definitely shows that the hard questions which need to be asked are starting to be asked.

DME bill being kicked around by the "Super Committee"
The Diabetic Medical Equipment reimbursement through Medicare and Medicaid and how it will be done by competitive bidding and if independent pharmacies of size 10 stores or less will be exempt is currently part of the larger debate of how to cut costs which the congressional "super committee" is contemplating. For more information on the specifics of the DME issue, click here.

My thoughts: What is at issue here is access to diabetic equipment (test strips, testers, and lancets) from smaller pharmacies, since obviously the larger pharmaceutical chains will be able to bid lower being able to supplement losses by sheer volume of sales. Living in Arizona, our senator, Jon Kyl is on the super committee and while he is not seeking reelection, it does provide us with some say in what is going on.

To contact Jon Kyl, click here.

Continual push against mandatory mail order
The popular trend to save money in healthcare is the concept that if mail order medications can save money for some individuals, then it must be able to save money for everyone. Thus there is a trend toward making mail order medication mandatory in insurance plans. NCPA has continued to push against this, demonstrating that in many cases mandatory mail order actually costs the taxpaying public far more than it saves. NCPA information

My Thoughts: In some rare cases I could see mail order medication saving money, such as a pharmacist ordering his or her own medication (if they don't own their own pharmacy). The need to have a personal relationship with a pharmacist who will take your medication list seriously cannot be overstated. My mother is a good and experienced pediatrician; she and my father both get their medications via mail order since it does cost less, but even still she let's me review their medication to look for issues that might come up.

Continual push toward transparent MACs
Maximum Allowable Costs are the ceiling price that pharmacies can get back for the product they have allowed to be sold in their store. Under the current system, there can be multiple MACs for different situations and PBMs can change MACs without letting pharmacies know of the change until after the product has been sold and gone. The government has begun to get involved in solidifying and making MACs transparent under a new system called NADAC (more information).

Continual push toward PBM transparency
There appears to be some progress in this front given the latest push from the Federal government (more information). NCPA stance, click here

Push toward collective bargaining rights
The issue here is if independent pharmacies can join together against contracts where because an individual pharmacy is so "small" the larger insurance company (PBM) can make it a take-it-or-leave-it contract, where the pharmacy has no choice but to accept the terms because it would hurt its patients' options.

5 Star rating system
The Centers for Medicare and Medicaid Systems (CMS) is implementing a 5 star rating system for insurance plans in order to promote consumer health and information. (Sadly, Wikipedia has a good summary )

My Thoughts: While this star rating system might be good, given that it takes patient opinion into account, it does not seem to take pharmacy and pharmacist opinion into account (I'm also fuzzy on if they take doctor opinion into account). This seems to leave those professionals who know the system, know how it works and how it can be played out of the rating system.

Continual push toward pharmacists being reimbursed for professional time
This continues to be the aim of most pharmacy organizations. Medicine Therapy Management has helped push towards this goal, but there continues to be a long way to go.

Updates from DEA
The focus of the DEA right now is shutting down "pain clinics" specifically in Florida, where individuals are being prescribed abuse potential controlled substances in large and uncontrolled quantities. (more information) The DEA is also holding manufactures and distributors accountable for selling and shipping such large quantities of drugs when it should be clear from the volume it is intended for questionably legal purposes.

The DEA is also aware of and disturbed by the current trend in society in thinking that pharmaceuticals are safe and ok to take, specifically referencing drug parties, where social goers bring random pills to add to a "candy bowl." Also they see an alarming number of high profile deaths due to prescription drug over dose.

The DEA is also very disturbed by the concept of medical marijuana, specifically referring back to the trend in society, they see it as associating two concepts, medicine and illegal drug, which only further strengthens the current trend in society, which leads to dangerous results.

My Thoughts: I really have nothing to add to the DEA's stance.

Use of NPI in reimbursement
When submitting claims for reimbursement specific information needs to be on the claim in order for the pharmacy to receive its claim. The environment seems to be shifting towards the NPI, National Provider Identifier, being the main means of identifying the prescriber in the claim.

That was a large update. Thank you for taking time to educate yourself on what's going on in pharmacy and as always, keep sending me information you find so I can incorporate it.

Tuesday, October 4, 2011

Do Secret Deals Create Savings? Uh-huh...

The Details:
The US Government is beginning to tackle the need for PBM's to be more transparent in their negotiations, sales and rebates. The PBM's claim this transparency would not allow them to get special discounts to pass savings on to their customers. (More info.)

My Feelings:
Normally I don't like using expletives, but this is one of the biggest lines of (insert your choice of a colorful metaphor here) I have ever heard. Basic rules of supply and demand indicate that initially when the consumer does not know roughly where the intersection of the two curves are, the consumer usually overpays. The seller can undersell too, but let's be honest here, if you run a business which is driven by stock market pressures to increase stock price, you are going to do your own studies to know where the intersection could lie. Thus they can claim to give the "best price" but nobody can prove it. And if you cannot prove it, given stock market pressures, you're going to try to get as much money as possible, whatever the means. How quickly will people do something against the law if they know they will not get caught? Same principle.

Also, thinking who the biggest consumer is, the government, it means more tax dollars of ours being spent on a non-transparent system.

Aggravating.