(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) released the following statement today supporting legislation introduced by Chairman Frank Pallone (D-NJ) of the House Energy and Commerce Subcommittee on Health:

“PCMA applauds the legislation introduced by Chairman Pallone earlier this week that would fix the flawed Average Manufacturer Price (AMP) final rule, mandated under the Deficit Reduction Act.

“PCMA supports the decision to remove PBM retail business rebates and discounts from inclusion in the final AMP rule. However, we remain concerned that mail-service and specialty pharmacy are still included in the definition of AMP. This definition is an inaccurate reflection of the retail class of trade price. Fixing AMP is important so that pharmacists can receive adequate reimbursements in Medicaid, ensuring consumers continued access to their community pharmacies.”

###

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

Contact Information:
Charles Coté 202-207-3605

(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) issued the following response to today’s statement by the National Community Pharmacists Association (NCPA):

“PCMA member companies have routinely paid clean claims within 30-days and have publicly pledged to continue doing so. Before rushing to judgment on the issue of ‘prompt pay,’ Congress should commission GAO to conduct an independent study to explore this issue generally and the role played by Pharmacy Service Administrative Organizations (PSAOs) particularly.

“PSAOs are the middlemen that thousands of drugstores hire to serve as billing intermediaries between payers and themselves. Often independent drugstores require payers to send reimbursements to PSAOs — which in turn process and forward payments to pharmacies. This ‘middle step’ could be causing delays even when Part D sponsors pay PSAOs on time. Regardless, requiring Part D sponsors to pay drugstores in 14 days is twice as fast as the 30-day payment cycle afforded Medicare physicians and hospitals and exceeds the payment requirements of 43 states.

“Furthermore, creating anti-trust exemptions for independent drugstores will only lead to increased costs for consumers. In any case, most independent drugstores already hire PSAOs to collectively bargain on their behalf for better terms with public and private payers.

“On another note, we agree that the current AMP (Average Manufacturer Price) calculation is unfair, inaccurate and should be changed.”

###

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

PCMA: Require E-Prescribing in Medicare

(Washington, DC)—The successful implementation of electronic (e) prescribing is saving the state of Mississippi’s Medicaid program $1.2 million per month according to a recent news article from Government Health IT. The savings and increased quality demonstrated in Mississippi reinforces the importance in requiring the technology in Medicare, the Pharmaceutical Care Management Association (PCMA) said today.

“The state of Mississippi should be congratulated for being on the leading edge in using e-prescribing to increase safety and savings for its Medicaid program,” said PCMA President & CEO Mark Merritt.

A recent study from the Gorman Health Group found that more than 70 percent of the savings and safety from e-prescribing arrives before the prescription is even written. E-prescribing provides the physician and patient with real-time clinical decision support on their prescription options, including whether a lower-cost preferred brand or generic drug is available. In addition, it provides a patient’s complete medication history, allowing the physician to determine whether any potential drug-to-drug interactions exist. Despite the obvious benefits, fewer than one in ten physicians use e-prescribing.

Following 18 months of savings, the Mississippi Division of Medicaid is negotiating with its contractor to expand its e-prescribing program, according to the article. In this instance, e-prescribing is helping to protect the most vulnerable population, those with lower incomes. Seniors across the country could also benefit from e-prescribing. A report released this week found dangerous drug side effects and deaths have more than doubled since 1998, with seniors disproportionately affected.

“Requiring e-prescribing in Medicare could prevent up to 1.9 million medication errors and save the federal government billions over the next decade, even after providing funds for equipment and savings,” added Merritt.

###

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

Contact Information:
Charles Coté 202-207-3605

PCMA: Time to Require E-Prescribing in Medicare

(Washington, DC)—A new report that finds dangerous drug side effects and deaths—particularly among seniors—has more than doubled since 1998 underscores the urgency for Congress to act now to require electronic (e) prescribing in Medicare, the Pharmaceutical Care Management Association (PCMA) said today.

“This study found that seniors are disproportionately affected by serious adverse drug events, which underscores why we need to require e-prescribing in Medicare immediately. Requiring e-prescribing in Medicare could prevent up to 1.9 million medication errors over the next decade,” said PCMA President & CEO Mark Merritt.

The report, published in this week’s issue of the Archives of Internal Medicine, analyzed serious adverse drug events received by the Food and Drug Administration (FDA) between January 1998 and December 2005, including death, disability and hospitalizations. The study found 467,809 such occurrences during the period studied, with the number of deaths due to drugs spiking from 5,519 to 15,107.

PCMA recently released a study from the Gorman Health Group that found requiring e-prescribing in Medicare could prevent up to 1.9 million medication errors over the next decade. E-prescribing technology helps consumers avoid adverse drug events by providing physicians with a comprehensive patient medication history and automatic electronic safety alerts before the prescription is sent to the pharmacy.

“By providing physicians with real-time safety alerts and their patients’ medication history, e-prescribing prevents dangerous drug-to-drug interactions and doctor shopping,” added Merritt

###

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

Contact Information:
Charles Coté 202-207-3605

PCMA Reaffirms PBMs Paying Clean Claims Within 30 Days

(Washington, DC)—Reaffirming that its member companies are paying clean Medicare Part D claims to pharmacies within 30 days, the Pharmaceutical Care Management Association (PCMA) today questioned whether independent drugstore bargaining organizations known as PSAOs could be a factor in late payments to pharmacies.

More than half of America’s independent pharmacies hire Pharmacy Service Administration Organizations (PSAOs) to centralize and streamline the following kinds of functions:

Collectively bargain with pharmacy benefit mangers (PBMs) to get favorable terms;

• Acquire rebates from drug companies; and
• Process claims/billing information on behalf of independent pharmacies.
• In these cases, while the pharmacy sends claims directly to the PBM, it requires the PBM to send reimbursements to the PSAO.
• After the PSAO receives the reimbursement from the PBM, it then pays the pharmacy.
• This middle step, which occurs at the request of the pharmacy, could be causing any delays that might be occurring.

“One factor that may be overlooked by the independent drugstore lobby is that their own bargaining groups—PSAOs—could be slowing down payments,” said PCMA President & CEO Mark Merritt. “When a PSAO is involved,” Merritt added, “there is no guarantee that claims paid promptly by PBMs aren’t getting held up by PSAOs. Since so many independent pharmacies use PSAOs, we’d hope that any study of payment practices thoroughly examines their role.”

While generating deeper-than-expected discounts for beneficiaries on their necessary prescription medicines, PCMA member companies are also paying all clean claims within 30 days. The 30-day pharmacy claims timeframe is a standard consistent with physician and hospital claims in Medicare Parts A & B, the Federal Employees Health Benefits Plan (FEHBP), and 43 states. Last year, a survey from the Centers for Medicare & Medicaid Services (CMS) found that 18 of the top 20 Medicare prescription drug plans (PDPs) were paying pharmacy claims on a twice-a-month billing cycle of 15 days or less. Reducing the payment cycle would increase costs by creating a new set of administrative burdens for Part D sponsors without providing any corresponding benefit to America’s seniors.

“Pharmacists deserve the same 30-day payment schedule that Medicare physicians and hospitals have. We certainly hope that independent pharmacies will evaluate the role of their own PSAOs to determine if reforms can be made there to speed the process along,” said Merritt.

Medicare PDPs and the proven pharmacy benefit management tools they utilize are saving beneficiaries and Part D $693 billion over the 2008 to 2017 period, including $43 billion in reduced prescription drug costs in 2008 alone, according to a recent analysis from PricewaterhouseCoopers (PwC).

###

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

Contact Information:
Charles Coté 202-207-3605