The Senate Finance Committee’s health care reform bill may shortchange pharmacies for Medicaid prescriptions, National Association of Chain Drug Stores president and chief executive officer Steve Anderson says.


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Senate health care reform bill raises concern

September 28th, 2009

WASHINGTON – The Senate Finance Committee’s health care reform bill may shortchange pharmacies for Medicaid prescriptions, National Association of Chain Drug Stores president and chief executive officer Steve Anderson says.

Anderson notes that following the unveiling of the bill, NACDS is “extremely concerned” about the consequences of the legislation’s 175% multiplier for federal upper payment limits (FULs) for generic drugs.

He says the bill could wind up “jeopardizing access to patient care in pharmacies and undermining incentives to dispense generic medications, which are so critical to reducing prescription drug expenditures.”

At the same time Anderson praises the committee for adopting a “weighted average manufacturer price [AMP] rather than the lowest AMP to set FULs,” as in the Deficit Reduction Act of 2005.

“A weighted average AMP would deliver a much-needed improvement that takes into account the wide range of market prices for generic drugs,” Anderson says. “In another related issue, we look forward to learning more about the definition of AMP under consideration by the committee, as it is essential that this definition only takes into consideration drug sales related to the retail class of trade, to prevent the inappropriate skewing of this model.”

Anderson also points out that reform bills include enhancement of community pharmacist-provided medication therapy management and an assurance of patient access to durable medical equipment — including diabetes testing supplies — at community pharmacies.

Late this month more than a dozen members of the NACDS board met with members of Congress to discuss the role of pharmacy in reducing costs and improving care. “The timing couldn’t be more critical as the Senate Finance Committee deliberates on health care reform,” stated Anderson. “NACDS continues to urge lawmakers to include pro-patient, pro-pharmacy policies in those deliberations.”

The committee’s proposed 10-year $856 billion health care overhaul was released in September by chairman Max Baucus (D., Mont.) with no Republican backing. As well as being less expensive than other reform bills, the legislation steers clear of the government-run insurance sought by some. Instead, it would expand coverage by establishing a network of nonprofit health insurance cooperatives.

The Congressional Budget Office (CBO) says the bill would leave 25 million people uninsured in 2019, down from the current 46 million. About one-third of those not covered would be illegal immigrants. The CBO estimates that 17 million people would be left uninsured under reforms proposed by the House of Representatives.

The Baucus bill is likely to be revised as it winds through the committee to the Senate floor and then to negotiations with the House, which is considering more expensive, and broader, legislation.

Baucus has called the proposal “a good balanced bill” that can win passage in the Senate.
But the possibility of legislation reaching President Obama’s desk by the end of the year, as he has requested, is hard to assess. In seeking a centrist plan, Baucus displeased many liberal Democrats as well as Republicans.

“The proposed co-op model is untested and unsubstantiated,” stated Sen. Jay Rockefeller (D., W.Va.).

Baucus subsequently said he would revise the bill to provide more help to moderate-income Americans and to lessen the impact of a tax on health insurance policies.

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