Thursday, December 3, 2009

More on HR 3590

Well, I've pulled up Section 2503 of HR 3590 to take a look at how the federal government is going to try to reign in prescription medication expenses for the Medicaid program. Does it surprise any pharmacist out there that the legislation is worded in such a manner that we will basically get the shaft when it comes to reimbursements for Medicaid prescriptions?

In the legislation, the federal upper limit is defined as "no less than 175 percent of the weighted average... of the most recently reported monthly average manufacturer prices..."

There are a couple problems that I see with this.

First, for calculating the FULs, HR 3590 includes the following text: "The Secretary shall implement a smoothing process for average manufacturer prices."

Do you know what that means? It means that the government can fudge the AMPs to whatever it wants. The Secretary is directed to do so. And there's not a darn thing we can do about it except drop out of the contract.

Secondly, it mentions the most recently reported average manufacturer prices. How much lag time is there going to be in these reports. Last year when generic Micro-K 10mEq was in short supply I called one of the insurance companies to have them review the reimbursement levels as my pharmacy was losing over ten bucks per script. Their response... we review AWPs and MACs on a quarterly basis. Do you think that the federal government is going to respond to price changes in a more timely basis? This pharmacist doesn't think so.

So I'm going to question the APhA as to why they are not addressing this issue with the sponsors of the bill. I can't find anything at the website to make me think that they are even paying attention to the bill. I mean except for applauding the legislators for including the almighty MTM in the bill.

Pharmacists, pay attention to the bill.

Read the bill.

Our profession may hang in the balance.

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