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Health bill OK’d by House has key Rx provisions

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In a late night vote, the House of Representatives gave final approval to a sweeping health care reform package in a landmark victory for President Barack Obama — and a win for pharmacy retailers.

The 219-212 vote by the House on Sunday sends the $940 billion bill to Obama to sign into law. For pharmacies, the legislation includes key provisions in Medicaid reimbursement, medication adherence and accreditation for selling durable medical equipment, industry trade groups noted.

WASHINGTON — In a late night vote, the House of Representatives gave final approval to a sweeping health care reform package in a landmark victory for President Barack Obama — and a win for drug store retailers.

The 219-212 vote by the House on Sunday night sends the $940 billion health care overhaul bill, already passed by the Senate, to Obama to sign into law. The legislation represents the president’s top domestic policy item, and its failure to pass Congress could have brought devastating political consequences for his administration and Democrats. Not a single Republican House member voted in favor of the bill.

Seen as the most far-reaching health policy change since the creation of Medicare, the measure expands health coverage to 32 million uninsured Americans and requires everyone to have health insurance coverage. Other key elements include subsidies to help people buy health insurance; an expansion of the Medicaid program for the poor; new taxes on the wealthy to help pay for the broadened health coverage; and tighter regulations on health insurers, notably barring the practice of refusing coverage to people with pre-existing health conditions.

For the retail pharmacy sector, the health reform legislation passed Sunday by the House carries three key provisions that were part of the bill approved by the Senate in December, the National Association of Chain Drug Stores and the National Community Pharmacists Association said Monday.

Those provisions include a series of grant and pilot programs that include medication therapy management (MTM); improvements to the Medicare Part D MTM benefit; reductions in cuts to Medicaid pharmacy reimbursement under the average manufacturer price (AMP) model; and a conditional exemption for pharmacies from the durable medical equipment (DME) Medicare accreditation requirements.

"The important takeaway is that pharmacy’s provisions have been maintained through another step in this process," Steve Anderson, NACDS president and chief executive officer, said in a statement. "Some very supportive leaders on Capitol Hill stepped up and kept these issues in the mix, and we appreciate their pro-patient, pro-pharmacy commitment."

NCPA noted that the pharmacy provisions in the legislation will improve community pharmacists’ ability to improve patient outcomes and reduce costs.

"The pharmacy provisions in the health care bill passed by the House of Representatives are welcome steps towards improving the delivery of prescription drug services to patients across America," commented Bruce Roberts, executive vice president and CEO at NCPA. "Once the bill becomes law, many community pharmacies can continue serving Medicaid patients as well as offering Medicare beneficiaries essential medical supplies, like diabetes testing strips."

NACDS noted that the advancement of the MTM provisions shows that pharmacy "will own the issue of medication adherence." The association has said that pharmacist-led MTM services can help reduce the estimated $290 billion in annual costs that result from poor medication adherence, amounting to 13% of all health care outlays.

On the Medicaid front, the legislation includes important changes in the definition and method of calculating AMP, as compared with the Deficit Reduction Act of 2005. NACDS called the changes "essential to achieving a better approximation of pharmacies’ costs for purchasing generic drugs."

The bill also would ensure federal upper limits (FULs) are set using a multiplier of "no less than" 175%, which NACDS pointed out is much higher than the levels set under the Deficit Reduction Act of 2005. The association said that it and other pharmacy groups fought to prevent congressional negotiations from settling on a multiplier of less than 175% and now aim to work through the regulatory process to boost the multiplier — for which the "no less than" language is deemed critical.

Meanwhile, the conditional exemption for pharmacy from the accreditation requirement for providing DME to Medicare beneficiaries will help maintain seniors’ access to needed products from their local pharmacies, according to NACDS. Pharmacies are state-licensed and reputable health care providers, and other such providers have been afforded this exemption, the association explained.

"As we have said all along, advancing NACDS’ priorities will require continued vigilance as the legislative process unfolds and into a regulatory process," Anderson stated. "This in many ways is still the early stage of our campaign to advance pharmacy’s value and viability as the face of neighborhood health care. We very much appreciate and value those pharmacy champions in Congress who are standing with us."

NACDS added that the AMP, MTM and DME accreditation provisions were among the key issues advocated by the chain drug industry during RxImpact Day on Capitol Hill earlier this month. At the event, more than 250 NACDS members, pharmacy school students and faculty, state pharmacy association representatives and other pharmacy advocates held more than 220 meetings with the elected officials in Washington. In addition, more than 1,500 letters were sent to Capitol Hill during the "virtual Hill day" that supplemented the in-person meetings.

NCPA’s Roberts also highlighted the pharmacy sector’s legislative input during the health reform push. "Throughout this entire health care reform process, community pharmacists have offered constructive solutions," he pointed out. "The effective and efficient delivery of prescription drug services can produce considerable benefits, as demonstrated by examples like the Asheville Project. Community pharmacists’ effort to be a positive force for change will not end when this bill becomes law. Other challenges remain, and the implementation process will require our input to ensure the transition is a smooth one."

Next in the process for the health reform legislation, expected to be signed into law by Obama this week, is Senate approval of a companion package of changes — a so-called "fix it" bill — also passed by the House on Sunday. Observers say Senate Democrats hope to pass the measure without changes and dodge parliamentary maneuvers by Republicans so it could be sent it straight to Obama.


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