Trumm Drug

HOW HEALTHCARE REFORM AFFECTS PHARMACY?

There has been a lot of activity recently regarding healthcare reform, specifically, the Patient Protection and Affordable Care Act (H.R. 3590). Here are a few points of that bill that affect the pharmacy business, pharmacists as healthcare providers and ultimately, all Americans.

Closing the Medicare D “Donut Hole”
The healthcare reform bill closes the donut hole over 10 years. Through federal funds and discounts from manufactures of brand name drugs, more Part D patients can continue therapies previously forgone in donut hole financial decisions.

Pharmacist-Delivered Medication Therapy Management Services (MTMS)
The bill envisions a new health care model with expanded patient care roles for pharmacists. MTM helps assure more appropriate use of medications, especially in chronic illnesses. MTM grant funding will help test MTM methods, which will save an estimate $290 billion in healthcare expenditures that result from inappropriate use or compliance with taking medications.

Pharmacy Benefit Manager (PBM) Transparency in Health Exchanges
PBMs contract with insurance plans to manage the processing of prescriptions. Currently no federal regulations exist to hold PBMs accountable for their profits or the tactics used to drive them. The reform bill requires some PBMs to disclose financial information to the Secretary of Health and Human Services, the first such federal oversight in this marketplace. Transparency encourages plans to hold PBMs accountable for excessive profits and helps level the playing field between PBM mail order pharmacies and independent pharmacies.

Pharmacies exempted from Medicare DME Accreditation Requirement
The bill allows pharmacies that meet specific criteria exemption from the burdensome and expensive accreditation process. Previously, pharmacies were the only healthcare providers required to complete the accreditation process.

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