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NACDS vigilant as health care reform bill nears passage

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WASHINGTON — Democrats in the House and the Senate are now working to reconcile their visions of health care reform legislation, hoping to pass a final bill before President Obama’s State of the Union address.

As expected, the Senate passed its version of the bill in a 60-39 party-line vote on Christmas Eve.

“We are now incredibly close to making health insurance reform a reality,” Obama said. “This will be the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health care system since Medicare passed in the 1960s.”

Many observers believe that the final bill that emerges from negotiations between the House and Senate will be closer to the Senate version, given that Democrats in the Senate cannot spare a single vote without threatening the bill’s chances.

That is mainly good news for pharmacy operators, according to the National Association of Chain Drug Stores, which says it prefers the Senate version’s provisions related to Medicaid pharmacy reimbursement and the average manufacturer price (AMP) model.

“One of NACDS’ top priorities has been to reform this badly flawed reimbursement model,” the association noted in a statement. “Among the ways in which the Senate bill is preferable to the House bill is that the Senate bill would ensure federal upper limits are set using a multiplier of ‘no less than’ 175% — much higher than the 130% used in the House bill.”

NACDS aimed to maintain such other key elements of the Senate’s approach to the AMP issue as those related to how AMP is defined and calculated. (At the same time, the association does prefer the House’s approach to the public posting of data over the Senate’s take on the issue.)

NACDS also prefers the Senate version’s provisions for the accreditation of pharmacies to sell durable medical equipment (DME), although it prefers the House version’s provision on the DME surety bond requirement. NACDS sides with the Senate version with regard to the study of a transition of the coverage of vaccinations from Medicare Part D to Medicare Part B.

NACDS said it would work during the reconciliation process to support the maintenance of provisions related to pharmacy-provided medication therapy management, and would express its reservations about the impact of any public plan on pharmacy services.

The National Community Pharmacists Association (NCPA) has also weighed in on the shape the final health care reform bill should take.

In a letter to Speaker of the House Nancy Pelosi and Senate Majority Leader Harry Reid, NCPA urged that Congress reform the Medicaid AMP reimbursement system for generic drugs.

Like NACDS, the group also backed the Senate’s federal upper limit of no less than 175% of the weighted average AMP for Medicaid pharmacy reimbursements. NCPA argued that because independent community pharmacies serve an extraordinarily high number of Medicaid patients, lower reimbursement rates could force many out of the program.

NCPA supports combining the House-passed transparency provisions for pharmacy benefit managers (PBMs) operating in the proposed health insurance exchange with Senate-approved language that would extend the reporting requirements to Medicare Part D drug plans. NCPA contended in its letter that a broad coalition of consumer and labor advocates also supports PBM transparency, arguing that it would provide a mechanism for rooting out wasteful spending.

NCPA’s letter also backs the Senate’s proposal to exempt pharmacies that derive no more than 5% of their prescription drug sales from DME, from Medicare’s DME “burdensome” accreditation requirements.

The Senate and House bills both would require most Americans to have health insurance coverage, and would provide subsidies to make such coverage affordable for those with lower or middle incomes.

The biggest difference in the bills is the “public option,” called for in the House version, but not in the Senate’s bill.


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