Trumm Drug

November 2009 Drug News

Minnesota / Drug payments put poor at risk, suit claims

Pharmacy trade groups are suing Minnesota and at least three other states, claiming their Medicaid programs underpay them for the cost of dispensing medication.

Unless Minnesota increases its payment rates, the trade groups argued, many independent pharmacies will close and many chain pharmacies will stop dispensing to the poor and disabled who are covered by the state’s Medicaid programs.

“The failure to act by Minnesota has produced a perverse outcome whereby underserved patients who need access to health care the most will get it the least,” said Bruce Roberts, executive vice president of the National Community Pharmacists Association.

The Minnesota lawsuit was filed in federal court Friday, one day after similar complaints were filed against California, Washington and New York.

The suit is an outgrowth of a prior legal settlement involving First DataBank – whose publications on the wholesale cost of prescription drugs have long influenced how much private and public insurers pay for drugs and pharmacy services.

The company was accused of conspiring with a drug wholesaler to artificially raise the price of prescription drugs. In a settlement, the company agreed to reduce its listed wholesale prices as of Sept. 26.

The reduction means a cash windfall for state governments, which can spend less on prescription drugs. But it also means less money paid by the state to local pharmacies – which have already absorbed Medicaid rate cuts in recent years.

The trade groups argued that states have an obligation under federal regulations to adjust their rates so that pharmacies don’t lose money. North Carolina and New Jersey are among the states that have already done so. State leaders should also be concerned that Minnesotans will have less access to pharmacists, who will lose money with each prescription under the current payment formula and eventually have to close, said Julie Johnson of the Minnesota Pharmacists Association.

“This will break their backs,” she said.

Johnson said the current state budget doesn’t rely on any savings due to the reduced wholesale prices. As a result, she is hopeful the state will adjust payment rates to pharmacists. Lawmakers will discuss the issue at a hearing Monday.

In a written statement, a spokesman for the Minnesota Department of Human Services said the agency is “confident” that its pharmacy payment rates meet state and federal laws.

By Jeremy Olson

Medicare Part D Premiums To Rise 11% In 2010: Report

The average monthly premium for Medicare prescription drug plans will increase to $38.85 in 2010, 11% higher than this year, according to an analysis based on the latest information released by the Centers for Medicare and Medicaid Services (CMS). Kaiser Family Foundation Report

Incentives Spur More Doctors To E-Prescribe

The number of physicians and other healthcare professionals who prescribe electronically is expected to more than double this year, attracted by higher Medicare payments tied to the technology’s use, according to the latest data released by SureScripts. “There’s no questions that the federal incentives are working,” stated Harry Totonis, president and chief executive of Surescripts. The Wall Street Journal (WSJ Subscription Required) Meanwhile, despite federal stimulus money, hospitals have been slow to join health information exchanges, even when they are readily available. Crain’s Detroit Business

Senate Bill Seeks To Bar Generic ‘Pay For Delay’ Deals

The Senate Judiciary Committee approved a bill that would bar deals between brand-name and generic drugmakers that delay competitive generic drugs from entering the market. Reuters

Key Pharmacy Provision Included in Senate Finance Committee Bill

The Senate Finance Committee last week passed a health care reform measure that includes several provisions ensuring the ability of community pharmacies to continue providing critical services to patients. The vote was 14-9.

“We commend the Senate Finance Committee, under the leadership of Chairman Max Baucus (D-Mont.), for its work,” said Bruce T. Roberts, RPh, NCPA executive vice president and CEO. “Chairman Baucus understands the significant role community pharmacies play, and we appreciate his support.

“The bill’s Medicaid generic reimbursement level is a very good start to protecting beneficiary access to community pharmacies while avoiding severe cuts that would do the opposite. We want to continue to work with the Senate and the Congress to assure that the level remains high enough for community pharmacies to continue to keep their doors open and provide pharmacy services to Medicaid patients.

“The exemption from Medicare’s durable medical equipment accreditation regulation preserves seniors’ access to diabetes testing supplies and other essential goods. Pharmacists are already state-licensed and other health care providers are exempted.

“The amendment from Senator Maria Cantwell (D-Wash.) will lead to transparency regarding the deals pharmacy benefit managers (PBMs) – the administrators of prescription drug plans – reach with drug manufacturers. Currently, PBMs retain much of these payments before sharing the rest with employers and patients. PBM profits have ballooned – up 20% last year alone – at the expense of everyone else confronting higher insurance premiums. While PBMs claim transparency increases costs, a thorough analysis by the Congressional Budget Office deemed it budget neutral. Ultimately, savings will be found as a result of this transparency provision, as Medicare, the Pentagon, and the State of Texas are experiencing, among others.

“Now our attention turns to the melding of the separate Senate Finance and HELP committee bills into one bill that will be considered by the full Senate. While some portions of the bill do raise concerns for community pharmacies, we urge the Senate leadership to keep these and other pharmacy-friendly provisions in that bill, because they are also patient-friendly, and that’s what everyone should be striving for if America’s health care system is truly going to be reformed for the better.”

Diabetes Drug Linked To Pancreas Inflammation: FDA

FDA notified healthcare professionals and patients that it had received 88 reports of acute pancreatitis in people taking Januvia (sitagliptin) and Janumet (sitagliptin/metformin), Merck’s type 2 diabetes drugs, and had revised the drugs’ prescribing information to include the reported cases. Merck stated that a thorough review of the clinical trial data and post-marketing reports did “not demonstrate that a causal relationship exists between sitagliptin and pancreatitis.” The Wall Street Journal, FDA Press Release, Merck Statement

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