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Rx seeks a bigger role in Medicaid, Medicare

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WASHINGTON ­— Medicare and Medicaid recently passed the half-century mark, and the National Association of Chain Drug Stores envisions an enhanced role for pharmacists in both programs, particularly Medicaid.

Congress, too, is looking for opportunities to strengthen and sustain Medicaid. Last month the House Energy and Commerce subcommittee on health held a hearing titled “Med­icaid at 50: Strengthening and Sustaining the Program,” and NACDS submitted a statement for the hearing.

In its statement, NACDS emphasized the role pharmacy plays in providing convenient, accessible and cost-effective health services to Medicaid beneficiaries in partnership with health care entities and other providers to improve health outcomes. “As the face of neighborhood health care, community pharmacies and pharmacists provide access to Medicaid prescription medications and over-the-counter products, as well as cost-effective health services such as immunizations and disease screenings for Medicaid beneficiaries,” NACDS wrote in its statement.

NACDS cited the continued expansion of state Medicaid enrollment as a result of the implementation of the Affordable Care Act, enabling pharmacists to provide services to Medicaid patients.

In the statement, NACDS stressed the importance of the release and timing of the Centers for Medicare and Medicaid Services’ (CMS’) Final Rule on Medicaid Covered Outpatient Drugs and emphasized the importance of allowing states adequate time to implement average manufacturer price (AMP)-based federal upper limits (FULs) and adjust corresponding dispensing fees.

“CMS must allow states adequate time to implement AMP-based FULs and adjust corresponding dispensing fees that ensure Medicaid drug reimbursement does not fall below drug acquisition cost and that Medicaid beneficiaries continue to have access to critical prescription drugs,” NACDS wrote.

Collectively, notes The New York Times, Medicare and Medicaid insure more than one-third of Americans. Both are undergoing a significant transition as private health insurance companies are playing a rapidly growing role in both.

Over 30% of the 55 million Medicare beneficiaries and well over half of the 66 million Medicaid beneficiaries are now in private health plans run by insurance companies. Enrollment has soared as the government pays private insurers to provide and coordinate medical services for more and more beneficiaries, providing more opportunities for pharmacists.

“Pharmacists play a vital role in advancing the health, safety and well-being of Medicaid beneficiaries,” said the NACDS statement. “Through personal interactions with Medicaid beneficiaries, face-to-face consultations and convenient access to preventive care services, local pharmacists are helping to shape the future of the Medicaid program — in partnership with doctors, nurses and others.”

The trade group encouraged Congress to act “to prevent potentially harmful alterations” to the Medicaid drug benefit. Doing so would ensure that community pharmacies can continue to offer positive and valuable health care services and benefits to Medicaid beneficiaries, asserted NACDS.


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