ALEXANDRIA, Va. — With Senate and House leaders trying to craft a health care reform bill to send to the White House, the National Community Pharmacists Association has once again called for the legislation to exempt pharmacists from DMEPOS accreditation.
The association has been pushing hard for such an exemption from CMS' accreditation mandate, arguing the agency has already let 17 other medical providers off the hook but is requiring pharmacists to undergo a "time-consuming, expensive and redundant" process since they are already subject to regulations and fines at the state level. NCPA officials have also said that while the accreditation regulation is supposed to prevent fraud, there is little evidence that pharmacists are involved.
In a Jan. 6 letter to House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., NCPA said the final reform measure should "assure seniors access to essential durable medical equipment (DME) by adopting the Senate's proposal to exempt from Medicare's burdensome, duplicative accreditation requirements those pharmacies that derive no more than five percent of total prescription sales from DME, such as diabetes testing supplies."
As the October 2009 accreditation deadline approached, Congress gave pharmacists a 90-day extension until Dec. 31, and there are provisions in both the House and Senate reform bills that would permanently exempt certain pharmacies from the requirement. Even so, the NCPA is encouraging its members — some 23,000 independent pharmacies across the country — to complete accreditation.
So is CMS. In a late December memo, the agency said it would continue to process accreditation determinations for pharmacies after Jan. 1 but also noted pharmacies should complete their applications "as soon as possible." Revocations for those not meeting the requirement "will be prioritized based on any potential beneficiary access issues as well as the agency's workload," according to the memo.
The NCPA also asks that a pharmacy surety bond exemption included in the House bill be part of the final legislation.
In other recommendations for the health reform bill, the NCPA said it should:
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Reform the Medicaid Average Manufacturer Price (AMP) reimbursement system for generic drugs and adopt, at a minimum, the Senate's federal upper limit of no less than 175 percent of the weighted average AMP. "Anything less could force many independent community pharmacies, which care for an extraordinarily high number of Medicaid patients, out of the program," the association said.
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Combine House-passed transparency provisions for pharmacy benefit managers (PBMs) operating in the proposed health insurance exchange with Senate language extending the reporting requirements to Medicare Part D drug plans.
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Support all House and Senate-passed provisions expanding the community pharmacist's ability to provide medication therapy management services to maximize the patient's adherence and therapeutic benefit while lowering the cost of inappropriate prescription drug use — estimated at $290 billion annually.
NCPA's letter also raises questions about how a new, government-sponsored public option would impact independent pharmacies, both in terms of reimbursement as well as small business health insurance requirements; suggests alternatives to a costly proposed mandate under Medicare; cautions against any federal pre-emption of state-based "any willing provider" laws; opposes moving Medicare vaccination coverage into the Part B program; backs safeguards to prevent 340B, low-income drug subsidies from being diverted to hospital employees and others; seeks clarification that any provision allowing the government to set Medicare drug prices not apply to pharmacy reimbursement; and supports House-passed language to close the Medicare Part D coverage gap, or "donut hole."
"Community pharmacists are ready and willing to help improve health outcomes and lower costs," said NCPA Executive Vice President and CEO Bruce Roberts, RPh, in a release. "The recommendations we present here will make a good thing even better for patients."
