Catching Up from the Summer

The big event occurring over the summer was the Supreme Court upholding the Accountable Care Act (ACA). Read more here.

How this will effect pharmacy as a whole is still yet to be seen, but certain areas of pharmacy will need to react and change due to requirements and opportunities in the ACA that will begin starting in 2014.

These include:

• The Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation exemption. This has been in the process for awhile (Click here for more information).
• A new definition of Average Manufacturer's Price (AMP). Independent pharmacy considers the new definition flawed. (For history of issue look here and here).
• Medication Therapy Management Expansion.
• Medicare Part D Donut hole relief for seniors.
• 340B eligibility expanded to: critical access hospitals, sole community hospitals, rural referral centers, and free-standing cancer hospitals. (US government site on 340B)

Other aspects that will have some effect on pharmacy:
A separate ruling stated that the Federal government cannot penalize states for not expanding their Medicaid eligibility. In a way this blunts the law's teeth. Likewise, since twenty-six states sued the federal government over the ACA, these states are behind in the means of getting ready to implement the changes. How the federal to state relationship will play out is still to be seen.

For businesses, there is going to be a formula of determining health care coverage that must be purchased for employees and the penalties involved if such purchases are not made. There will also be formed the Small Business Health Options Program (SHOP) Exchanges in order to help smaller sized businesses shop competitively priced health insurance options for its employees.

There is likely still much to hear on the ACA in the months to come.

H.R. 1971 Update

With the election year underway, a lot of pharmacy politics have been burning in the back corner. H.R. 1971 is being debated (Hill news report here). This was the bill introduced in the summer of 2011 pushing for more transparency with PBMs.

Two issues of concern related to this bill are 1) overfilling and 2) glass house business (businesses being forced to make public their practice information).

My Opinions:
Regarding overfilling, I am not sure I fully understand the concern here. If the concern is overfilling of fraudulent prescriptions, currently in Florida the DEA is cracking down on pharmacies, pharmacists, doctors, and drug manufactures who combined are making the "pill mills" that exist there. While it seems the DEA feels they are understaffed/underfunded to be moving forward as efficiently as they would like, this problem is being addressed.

Regarding glass house business, I can feel a bit more empathy here. If you own a business, your goal is to make a profit by serving the individuals you are able to supply for, this includes PBMs. While PBMs due tend to get the negative flack from NCPA, and from instances I've seen, rightly so, they are still businesses, serving a need in the American health care system. Ideally, we would like to see all businesses working together in harmony to produce the best outcomes for patients while maintaining a respectable profit margin. (Realistically there will continue to be headbutting.) Combine that concept with the concept that you hold yourself to the same standard you hold others to, "judge not, lest you be judged." If PBMs by law must have their books become public knowledge, then reasonably so independent pharmacies must be ready and willing to do the same.

My point is: Fight hard for what you feel is right, but in doing so, don't overshoot and go too far.

Pharmacy Day on the Capitol in Arizona

The Details:
Pharmacy Day on the Capitl here in Arizona is coming up on Wednesday, January 25th. The main goal of this day is to give the profession of pharmacy a presence before those individuals who have influence in decisions made in the direction of our state.

It is a good idea to know who your legislators are prior to going to this event, since, it might be good to A) let them know you are coming and B) look for them there and let them know you are a voting member in their district and the issues you feel are most pressing to you (hopefully pharmacy has something to do with those issues).

If you heard last year, due to the US census data that came out, Arizona needs to redistrict the areas from where representatives are elected. There also was some not-so-nice political moves done to influence the outcome (more info. here and here), and the process is still being completed. That all being said, your representatives now might change, but still is good to know who they are.

To find your representative:

1. Go here
2. Enter your zip code in the bottom left hand corner
3. You will be shown a map with your district number, remember that
4. Next go here and find your one senate representative and your two house representatives.
5. Email, or even better call, your representatives and say "Hi, my name is ____________. You're my representative and I just wanted to let you know I will be outside the Senate/House on January 25th, next Wednesday from 10 AM to 2 PM, and I am excited to have you come out and let me show you the important benefits pharmacy can offer the state of Arizona, and how using pharmacists can alleviate some problems in the health-care issues you are facing. We can talk over lunch; we'll provide. Thank you so much and I look forward to seeing you."
6. Be ready to talk to your representatives about your passion for your profession. (You're spending at least $80,000 on it; you have to have some passion for it! Sorry, wrong section to say that in =P)

I will post information on what issues specifically the UoA will be talking about when I know which issues are considered most prominent.

My Feelings:
Pharmacy Day at the Capitol can be a very useful day. It gives some of us the first opportunity to get the nerve up to actually speak face-to-face with our legislators. This is government in the United States in action. Be a part of it; it is part of who you are being here. On the flip side, it can also become a pointless bit of show-and-tell, much like an elementary school science fair. The difference between the two is the passion you have for what you will do, not what you have done. Legislation is all about the future, as Mike Huckabee put it at the NCPA trade show in Nashville, it is about "aiming for the next bend." What you've done will demonstrate what you can do in the future, so use it as such. When you go to to Phoenix, have solidly in your mind the reason you are going into pharmacy. Yes, I think many of us want a good pay check and a stable career, but why did you choose pharmacy specifically, and what can you offer Arizona in the future? An personal and honest answer to that will make legislators sit up and listen, especially when they know you vote for them.

Making It Dot.pharmacy

The Details:
The Internet Corporation for Assigned Names and Numbers (ICANN), which is the international regulator of domain names on the Internet, is starting to accept applications to purchase new domain areas. Previously they limited the domains to .com, .edu, .net, .gov, and a few more, however; now they are opening it up to basically anything provided it is reviewed and found favorable.

More Information

My Feelings:
Its a new way of looking at the Internet. Previously you would have the entity's name followed by the suffix domain which described the entity. Now the suffix would be the entity. For big entities this is a boon, but for smaller entities this is a huge, near essential, resource purchase ($185,000 just to apply) that may never come to any use outside of simply protecting yourself. Does the pharmaceutical sphere as a whole buy that suffix? Who gets to control it then? Academia? Commercial pharmacy? Pharmacy Benefit Managers? Does one group buy it simply to stockpile it against another group? I don't know, but it seems to open up a concern for competition of that which is incredibly scarce, yet potentially useful in the increasing ubiquity of the Internet.