Puts Funding of Other Medicare Providers at Risk

(Washington, DC)—Legislation that would make Medicare prescription drug plans (PDPs) pay drugstores twice as fast as Medicare pays other providers could cost the program and its beneficiaries at least $3.1 billion over the next decade according to a new study by PricewaterhouseCoopers (PwC) that was commissioned by the Pharmaceutical Care Management Association (PCMA).

“The increased cost of making Medicare PDPs pay retailers twice as fast as doctors and hospitals are paid will almost certainly be financed at the expense of Medicare providers and beneficiaries,” said PCMA President and CEO Mark Merritt. “In a pay-go world, this would essentially be a wealth transfer from rural providers, Medicare Advantage plans, Skilled Nursing Facilities, beneficiaries, and others to independent drugstores.”

Currently, Medicare PDPs pay pharmacy claims within 30 days, a standard consistent with Medicare Parts A & B, the federal employees’ health plan, and the private sector. The 30-day payment standard allows plans to batch claims for administrative efficiency and conduct audits to detect fraud and abuse.

PwC: Impact of “Prompt Payment” Legislation on Medicare Costs

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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

PBMs Increase Access, Lower Drug Costs for America’s Seniors

(Washington, DC)—A new report released by the Office of Inspector General (OIG) finding that in Medicare Part D, generic drugs were dispensed 88 percent of the time when generic substitutes were available and that 56 percent of all drugs dispensed are generics confirms that proven pharmacy benefit manager (PBM) tools are driving down prescription drug costs for America’s seniors, said the Pharmaceutical Care Management Association (PCMA) today.

“As numerous other studies have found, Part D plans and the PBMs who them administer are driving increased generic utilization,” said PCMA President and CEO Mark Merritt. “This most recent report from OIG finding that 56 percent of all Medicare drugs dispensed are generics confirms that proven PBM tools are driving down costs and increasing access on prescription drugs for America’s seniors.”

Part D plans are achieving high generic utilization rates while complying with numerous Medicare coverage requirements. According to OIG, in Part D:

Proven PBM tools have resulted in overall costs for the Part D program coming in 30 percent less than originally estimated, according to the Centers for Medicare & Medicaid Services (CMS). PBMs will also save the Medicare program and its beneficiaries $693 billion over the 2008-2017 period compared to what expenditures would have been without active PBM management, according to PricewaterhouseCoopers (PwC).

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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

E-Prescribing Will Improve Savings, Reduce Medication Errors

(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) said today that the proposed standards for electronic prescribing (e-prescribing) released by the Centers for Medicare & Medicaid Services (CMS) confirm that the time is now to require e-prescribing in Medicare.

Following four years of extensive review by physicians, pharmacists, standard-setting organizations, and other stakeholders, CMS estimates tremendous savings and health benefits with increased adoption of e-prescribing. In the proposed standards, CMS estimates found that adoption of e-prescribing would:

Reduce Adverse Drug Events (ADEs);
Provide increased administrative savings to physicians, physician offices and pharmacists; and
Enhance generic utilization.
“CMS estimates even modest adoption of e-prescribing could save billions and greatly reduce adverse drug events (ADEs),” said PCMA President and CEO Mark Merritt.

The proposed e-prescribing standards were developed and pilot-tested during a rigorous process with consensus from a variety of influential health care stakeholders, including physicians; pharmacists; payers; the Department of Health and Human Services (HHS); the National Committee on Vital Health Statistics; and HIPAA-recognized standard setting organizations. In a positive note regarding interoperability, the proposed e-prescribing standards were created by the same organizations which developed Electronic Medical Records (EMR) standards. Requiring e-prescribing in Medicare is the first step toward broader adoption of overall health IT and would also serve as a model for the entire commercial market.

In the 2003 Medicare Modernization Act (MMA), Part D sponsors were required to accept e-prescribing and national standards were created for Medicare, however, physicians were not required to use the technology. As a result, fewer than one-in-ten physicians have chosen to use it. PCMA strongly believes the only realistic way to rapidly accelerate adoption of e-prescribing is to require physicians to use the technology in Medicare.

E-prescribing helps consumers avoid medication errors by providing physicians with real-time safety alerts when a new prescription would dangerously interact with others that have already been prescribed. Earlier this year, PCMA released a study from the Gorman Health Group showing that requiring e-prescribing in Medicare could prevent up to 1.9 million medication errors over the next decade and save billions — even after providing funds for equipment and training.

PCMA last week launched a TV and print advertising campaign featuring J. Lyle Bootman, Ph.D., Sc.D., who last year co-chaired an Institute of Medicine (IOM) committee that recommended that all physicians begin using e-prescribing by 2010. In the TV ad, Dr. Bootman calls on policymakers to require e-prescribing in Medicare, “before more people die.”

The new PCMA TV ad is available at www.pcmanet.org

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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.

PwC: Impact of “Prompt Payment” Legislation on Medicare Costs

IOM Expert Urges Congressional Action to Prevent Medication Errors

Washington, DC — A new TV and print advertising campaign launched today by the Pharmaceutical Care Management Association (PCMA) featuring Institute of Medicine (IOM) expert panelist J. Lyle Bootman, Ph.D., Sc.D. is calling on policymakers to require electronic prescribing (e-prescribing) in Medicare “before more people die.” According to the IOM, each year some 7,000 people die from medication errors.

Last year, Dr. Bootman co-chaired an IOM committee that recommended that all physicians begin using e-prescribing by 2010 to help reduce the estimated 1.5 million preventable medication errors that occur in the United States annually. Unfortunately, fewer than one-in-ten physicians currently use life-saving e-prescribing technology.

In the new TV advertisement, Dr. Bootman says that, “Thousands of people die every year because of preventable medication errors—many of them are America’s seniors.”

“Requiring e-prescribing in Medicare would dramatically improve patient safety and accelerate physician adoption of other life-saving health information technologies,” said PCMA President and CEO Mark Merritt.

In addition to the new television advertisement, PCMA also unveiled a new print advertisement with the headline: “While You Wait.” The print advertisement urges Congress to require e-prescribing in Medicare as a solution that will help prevent thousands of deaths annually from medication errors.

E-prescribing technology helps consumers avoid medication errors by providing physicians with real-time safety alerts if a new drug would dangerously interact with others that have already been prescribed. Earlier the year, PCMA 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 and save billions, even after providing funds for equipment and training. PCMA supports this option because it provides the greatest safety and savings opportunities.

In the 2003 Medicare Modernization Act (MMA), Part D sponsors were required to accept e-prescribing and national standards were created for Medicare. The MMA did not, however, require physicians to actually use e-prescribing and thus far fewer than one-in-ten physicians have chosen do so.

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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.

Last year, as part of its campaign to require e-prescribing in Medicare, PCMA launched a TV ad featuring Institute of Medicine (IOM) expert panelist J. Lyle Bootman that called on policymakers to require e-prescribing in Medicare “before more people die” from medication errors.

Dr. Bootman co-chaired an IOM committee that recommended that all physicians begin using e-prescribing by 2010 to help reduce the estimated 1.5 million preventable medication errors that occur in the United States annually. According to the IOM, each year some 7,000 people die from medication errors. Unfortunately, fewer than one-in-ten physicians currently use life-saving e-prescribing technology.

You may also click here to download the file.

Last year, as part of its campaign to require e-prescribing in Medicare, PCMA launched a TV ad featuring Institute of Medicine (IOM) expert panelist J. Lyle Bootman that called on policymakers to require e-prescribing in Medicare “before more people die” from medication errors.

Dr. Bootman co-chaired an IOM committee that recommended that all physicians begin using e-prescribing by 2010 to help reduce the estimated 1.5 million preventable medication errors that occur in the United States annually. According to the IOM, each year some 7,000 people die from medication errors. Unfortunately, fewer than one-in-ten physicians currently use life-saving e-prescribing technology.

If you are having trouble viewing this video, please make sure you have downloaded Windows Media Player.

You may also click here to download the file.

(Washington, DC)— In response to the House Judiciary Committee’s plans tomorrow to mark up legislation (HR 971) that would grant independent pharmacists sweeping antitrust exemptions, the Pharmaceutical Care Management Association (PCMA) issued the following statement:

“This expensive piece of legislation couldn’t have come at a worse time for policymakers and consumers alike. While most everyone is searching for new ways to save money on prescription drugs, this proposal would dramatically increase costs while providing no corresponding upside for consumers.

“This bill would give white collar business owners, whose median annual salary is $100,720[1], privileges usually reserved for blue collar union workers.

“By exempting pharmacies from antitrust laws, HR 971 would give independent pharmacies the right to collude to raise prescription drug prices. The pharmacy antitrust exemptions in this legislation would increase prescription drug costs for Medicare and commercial payors by up to 11.8 percent, or $29.6 billion over five years, according to an analysis from CRA International.

“HR 971 also fails to take into account the fact that most independent pharmacies already hire groups called Pharmacy Service Administrative Organizations (PSAOs) which collectively bargain on their behalf for higher payments in Part D and other programs. Independent pharmacies also use PSAOs to win rebates from drug manufacturers and to serve as a ‘go-between’ to process payments from PBMs and health plans.

“Additionally, rural pharmacies enjoy further leverage due to the broad pharmacy network access standards required in Medicare.”

Opposition to HR 971

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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.

[1] Salary.com: http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000011.html

Contact Information:
Charles Coté 202-207-3605