Icky
02-16-2007, 11:41 AM
[Only registered and activated users can see links]
__________________________
GAO Report Reveals CMS Will Stop Medicaid Patients from Using Their
Submitted by nick on Tue, 01/23/2007 - 10:39pm. Press Releases ([Only registered and activated users can see links])
News Release
National Community Pharmacists Association
[Only registered and activated users can see links] ([Only registered and activated users can see links])
F O R I M M E D I A T E R E L E A S E
CONTACT:
Carol Cooke
Senior Director, External Communications
National Community Pharmacists Association
100 Daingerfield Rd
Alexandria, VA 22314
(703) 838-2686
[Only registered and activated users can see links]
GAO Report Reveals CMS Will Stop Medicaid Patients from Using Their
Community Pharmacist
Thousands of Community Pharmacies Will No Longer Be Able to Participate in
Medicaid Under Proposed Reimbursement Changes
Alexandria, Va. - January 23, 2007 An analysis dated December 22, 2006, yet only released publicly yesterday by the Government Accountability Office (GAO), reveals that a new formula for reimbursing pharmacies that serve Medicaid recipients will result in pharmacists losing, on average, 36 percent on every Medicaid prescription they fill. “The Centers for Medicare & Medicaid Services (CMS) is effectively putting community pharmacies out of the Medicaid business,” said National Community Pharmacists Association Executive Vice President and CEO Bruce Roberts, RPh. “It will be the nation’s poor—in particular women and children who make up the majority of Medicaid recipients—who will suffer when they no longer have access to community pharmacies for the medicines they need.”
Continued reimbursement cuts in both Medicaid and the Medicare Part D program are threatening the existence of many independent community pharmacies. In many rural areas, the local independent is the only pharmacy serving the community, and this new reimbursement is a threat to its viability, presenting a real health crisis for local citizens. “In Indiana, for example,” said Roberts, “more than six percent of community pharmacies went out of business due to continually declining reimbursement. With this new Medicaid reimbursement cut, many more will suffer the same fate.”
Although Medicaid is a state-administered health program for the nation’s poor and disabled, the federal CMS is implementing a new congressionally-mandated formula for the maximum amount states may pay pharmacies in order to continue receiving federal matching funds. The Deficit Reduction Act of 2005 redefined these maximums, known as Federal Upper Limits (FULs), to be based on 250 percent of the lowest Average Manufacturer Price (AMP).
According to the report from GAO, which was based on a sample of the most prescribed and highest cost prescriptions used by Medicaid recipients, “estimated AMP-based FULs were, on average, 36 percent lower than average retail pharmacy acquisition costs.”
“In essence, CMS is forcing a pharmacy to accept payment that is 36 percent below its cost or stop participating in a program that provides prescription to our nation’s poor,” said Roberts. “For the average independent pharmacy, 92 percent of its business is prescription drugs, and a large portion of our patients are on Medicaid. Whether a pharmacy stops serving Medicaid patients, or is driven out of business, the consequences to the community are the same—patients who can least afford it will lose access to the pharmacy services they need, and more people will end up in the emergency room, costing taxpayers even more.”
“NCPA supports a fair and transparent system to reimburse pharmacists under Medicaid, but not a system that penalizes pharmacists for participating in the program,” said Roberts. “No small business can be expected to operate at a loss, and pharmacies are no exception.”
In concluding its report to Congress, the GAO noted that “[Medicaid] savings should be achieved while ensuring that reimbursements to retail pharmacies are adequate.” NCPA is currently working with Congress to redefine AMP so that it fully covers pharmacies’ costs, and ensures Medicaid recipients’ access to pharmacy services.
NCPA has repeatedly warned Congress and the administration that many independents, particularly those serving rural communities and those with a high percentage of Medicaid patients, will be forced out of business because of this new federal mandate. “This is not just about our businesses and bottom lines,” said Roberts. “This is about our patients and their access to quality health care.”
The National Community Pharmacists Association, founded in 1898, represents the nation’s community pharmacists, including the owners of more than 24,000 pharmacies. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines.
__________________________
GAO Report Reveals CMS Will Stop Medicaid Patients from Using Their
Submitted by nick on Tue, 01/23/2007 - 10:39pm. Press Releases ([Only registered and activated users can see links])
News Release
National Community Pharmacists Association
[Only registered and activated users can see links] ([Only registered and activated users can see links])
F O R I M M E D I A T E R E L E A S E
CONTACT:
Carol Cooke
Senior Director, External Communications
National Community Pharmacists Association
100 Daingerfield Rd
Alexandria, VA 22314
(703) 838-2686
[Only registered and activated users can see links]
GAO Report Reveals CMS Will Stop Medicaid Patients from Using Their
Community Pharmacist
Thousands of Community Pharmacies Will No Longer Be Able to Participate in
Medicaid Under Proposed Reimbursement Changes
Alexandria, Va. - January 23, 2007 An analysis dated December 22, 2006, yet only released publicly yesterday by the Government Accountability Office (GAO), reveals that a new formula for reimbursing pharmacies that serve Medicaid recipients will result in pharmacists losing, on average, 36 percent on every Medicaid prescription they fill. “The Centers for Medicare & Medicaid Services (CMS) is effectively putting community pharmacies out of the Medicaid business,” said National Community Pharmacists Association Executive Vice President and CEO Bruce Roberts, RPh. “It will be the nation’s poor—in particular women and children who make up the majority of Medicaid recipients—who will suffer when they no longer have access to community pharmacies for the medicines they need.”
Continued reimbursement cuts in both Medicaid and the Medicare Part D program are threatening the existence of many independent community pharmacies. In many rural areas, the local independent is the only pharmacy serving the community, and this new reimbursement is a threat to its viability, presenting a real health crisis for local citizens. “In Indiana, for example,” said Roberts, “more than six percent of community pharmacies went out of business due to continually declining reimbursement. With this new Medicaid reimbursement cut, many more will suffer the same fate.”
Although Medicaid is a state-administered health program for the nation’s poor and disabled, the federal CMS is implementing a new congressionally-mandated formula for the maximum amount states may pay pharmacies in order to continue receiving federal matching funds. The Deficit Reduction Act of 2005 redefined these maximums, known as Federal Upper Limits (FULs), to be based on 250 percent of the lowest Average Manufacturer Price (AMP).
According to the report from GAO, which was based on a sample of the most prescribed and highest cost prescriptions used by Medicaid recipients, “estimated AMP-based FULs were, on average, 36 percent lower than average retail pharmacy acquisition costs.”
“In essence, CMS is forcing a pharmacy to accept payment that is 36 percent below its cost or stop participating in a program that provides prescription to our nation’s poor,” said Roberts. “For the average independent pharmacy, 92 percent of its business is prescription drugs, and a large portion of our patients are on Medicaid. Whether a pharmacy stops serving Medicaid patients, or is driven out of business, the consequences to the community are the same—patients who can least afford it will lose access to the pharmacy services they need, and more people will end up in the emergency room, costing taxpayers even more.”
“NCPA supports a fair and transparent system to reimburse pharmacists under Medicaid, but not a system that penalizes pharmacists for participating in the program,” said Roberts. “No small business can be expected to operate at a loss, and pharmacies are no exception.”
In concluding its report to Congress, the GAO noted that “[Medicaid] savings should be achieved while ensuring that reimbursements to retail pharmacies are adequate.” NCPA is currently working with Congress to redefine AMP so that it fully covers pharmacies’ costs, and ensures Medicaid recipients’ access to pharmacy services.
NCPA has repeatedly warned Congress and the administration that many independents, particularly those serving rural communities and those with a high percentage of Medicaid patients, will be forced out of business because of this new federal mandate. “This is not just about our businesses and bottom lines,” said Roberts. “This is about our patients and their access to quality health care.”
The National Community Pharmacists Association, founded in 1898, represents the nation’s community pharmacists, including the owners of more than 24,000 pharmacies. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines.