Calling e-prescribing “the most important issue to patients in the current Medicare debate,” PCMA has unveiled a new ad campaign urging policymakers to require the use of electronic prescribing (e-prescribing) in Medicare. The new ad is a “wake up” call to refocus the Medicare debate on patients, not just the providers who serve them. From a patient’s perspective, e-prescribing is by far the most important issue in the current Medicare debate. Read More

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Ad is a ‘Wake Up Call’ to Refocus the Medicare Debate on Patients, Not Just Providers

PCMA’s New E-Prescribing TV Ad

(Washington, DC)— Calling e-prescribing “the most important issue to patients in the current Medicare debate,” the Pharmaceutical Care Management Association (PCMA) today unveiled a new TV, print, and online ad campaign urging policymakers to require the use of electronic prescribing (e-prescribing) in Medicare “before more people die.” The new ad, featuring a woman mourning at a gravesite, highlights the fact that more than 7,000 people die every year because of medication errors.

“This ad is a wake up call to refocus the Medicare debate on patients, not just the providers who serve them. From a patient’s perspective, e-prescribing is by far the most important issue in the current Medicare debate because it could save their life or the life of someone they love,” said PCMA President and CEO Mark Merritt. “Yet the debate focuses almost exclusively on providers, not patients. That needs to change.

“Meeting the financial needs of providers is important, but meeting the safety needs of patients is more important. Fortunately, e-prescribing addresses both issues since it saves lives and money,” added Merritt.

In December, the bipartisan “Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007″ that would require e-prescribing in Medicare was introduced by Senate Finance Committee Members John Kerry (D-Mass.) and John Ensign, (R-Nev.). The legislation enjoys support from 12 additional co-sponsors, including Senators Debbie Stabenow (D-Mich.), John Sununu (R-NH), Joe Lieberman, (I-Conn.), and Hillary Rodham Clinton (D-N.Y.). Companion legislation was introduced in the House by Representatives Allyson Schwartz, (D-Penn.) and Jon Porter, (R-Nev.) and currently has 29 total co-sponsors. Both bills are supported by a broad coalition of consumers, unions, businesses, purchaser groups, and other prescription drug stakeholders.

For the past year, PCMA has been leading the charge to require electronic prescribing in Medicare. To jumpstart the debate, PCMA released a study from the Gorman Health Group showing that e-prescribing could prevent up to 1.9 million medication errors and save the federal government billions over the next decade — even after providing physicians funds for equipment, training, and technical support.

In addition, 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. 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. The IOM, in making its recommendations, cited the high number of adverse drug events that result from the present system of hand-written prescriptions â?? as well as the number of dangerous drug interactions that could be stopped if physicians utilized electronic prescribing.

Eighty-one percent of physicians say widespread use of e-prescribing would reduce medication errors. Unfortunately, fewer than one-in-ten physicians currently use the technology.

The first step toward electronic health records (EHRs) is to require e-prescribing in Medicare. E-prescribing technology is ready for widespread adoption following the recent release of the final electronic prescribing standards in Medicare by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that adoption of e-prescribing would reduce adverse drug events (ADEs); provide increased administrative savings to physicians and pharmacists; and enhance generic utilization. E-prescribing technology enjoys strong support from the Administration, with Health and Human Services (HHS) Secretary Mike Leavitt stating that the e-prescribing standards are in place and that “it’s time” to adopt the technology.

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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.

(Washington, DC)— The Federal Court of Appeals for the District of Columbia, in a unanimous 3-judge decision, today issued an opinion supporting the position of the Pharmaceutical Care Management Association (PCMA) and holding that it is entitled to renew its constitutional challenge to the fiduciary-disclosure provisions of the District of Columbia’s AccessRx Act of 2004.

Last year, a lower court vacated PCMA’s original preliminary injunction that had prevented the D.C. law from going into effect. Relying on the doctrine of collateral estoppel, the lower court determined that PCMA was prevented from challenging the law because a similar Maine law had been upheld by the First Circuit Court of Appeals in PCMA v. Rowe.

However, in today’s opinion, the D.C. Circuit found that collateral estoppel was not applicable, and could not be used to keep PCMA from having its day in court. The Appeals Court now holds that any such preclusion “would freeze the development of the law in an area of substantial public interest.” The case now returns to the lower court for consideration on the merits, including PCMA’s contention that the D.C. law conflicts with federal benefits law (ERISA) as well as the First Amendment to the U.S. Constitution.

“We’re pleased that the Court has chosen to allow PCMA to pursue this challenge,” said PCMA President and CEO Mark Merritt. “PCMA has always maintained that the D.C. law is misguided and would only increase prescription drug costs for District residents and employers.”

Since 2003, 31 states have rejected legislation imposing similar PBM fiduciary-disclosure requirements, realizing these proposals would provide drug manufacturers the opportunity to charge consumers and employers higher drug prices. For these reasons, a broad coalition of consumers, Fortune 500 employers, labor unions, health insurers, and others have worked together to defeat these proposals in states across the country. Furthermore, numerous independent data from the Congressional Budget Office, the Federal Trade Commission, and others have concluded that public disclosure of drug pricing information alone could increase prescription drug costs by about 10 percent.

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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.

Washington, DC)— The Pharmaceutical Care Management Association (PCMA) issued the following statement in response to today’s article in The New York Times on skyrocketing biotech prices:

“Americans currently spend $50 billion on biotech products and will spend $100 billion within a few years. The reason biotech drugs have such high prices is because they don’t face generic competition once their patents expire. The absence of generic biotech products is a huge challenge for payors since the branded products can cost hundreds of thousands of dollars annually.”

“Monopoly pricing of biotech products is wrong. Fortunately, there is a public policy solution: legislation that would establish a clear FDA pathway for approval of generic biotech products or biogenerics.”

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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.

New Survey and Ad Highlight Fraud, Waste, and Abuse Problem

Merritt: ‘Small Pharmacies Can Be Especially Vulnerable’

(Washington, DC)— A new survey of experts responsible for detecting and preventing pharmacy fraud, waste, and abuse in Part D finds that proposals requiring drugstores to be paid twice as fast as other Medicare providers would increase costs and make it more difficult to fight fraud, waste, and abuse, the Pharmaceutical Care Management Association (PCMA) said today. In addition to the new survey, PCMA is also launching a print advertising initiative that highlights how “finding the bad apples isn’t easy” in detecting fraud, waste, and abuse and that proposals mandating “prompt pay” would make it even tougher.

“‘Protect Your Pharmacy Week’ is a good time to focus on safeguarding the tools needed to fight increasingly sophisticated and aggressive fraud tactics. Finding the bad apples isn’t always easy and small pharmacies can be especially vulnerable,” said PCMA President and CEO Mark Merritt. “Part D plans employ a variety of state-of-the-art techniques when working with pharmacies and other stakeholders to combat fraud, waste, and abuse. Making plans pay drugstores twice as fast as other Medicare providers would increase costs and make fighting fraud, waste, and abuse more difficult.”

Survey findings include:

· Pharmacy Fraud, Waste, and Abuse Is Costly: Approximately 1 percent of prescription costs are likely due to fraud, waste, or abuse. This amounts to hundreds of millions of dollars in unnecessary costs for the Medicare Part D program and its beneficiaries.

· Part D Plans Use Advanced Techniques to Combat Fraud, Waste, and Abuse: Part D plans use sophisticated software and auditing techniques to identify problematic prescription claims. Most plans screen for fraud, waste, and abuse both before and after a claim is paid. Problem claims can often be detected automatically, but auditors must then analyze the claims and often contact the pharmacy, doctor, or patient for additional information to

· Problem Claims Can Be Caught Prior to Payment: Typical examples of fraud, waste, and abuse detected prior to a claim being paid include prescription claims submitted with the improper quantity, improper days supply, improper coding, duplicative claims, and other irregularities.

· “Prompt Payment” Mandates Would Increase Costs: Accelerated payment cycles would make it difficult or impossible to complete some fraud, waste, and abuse detection efforts that currently occur prior to payments being made. While the majority of payments made on claims involving fraud, waste, or abuse can eventually be recovered, this can be difficult, time intensive, and, in some cases, impossible. This results in increased costs.

· Independent Pharmacies Tend to be More Vulnerable to Fraud than Large Chain Pharmacies: Unlike independent pharmacies, large chains have centralized billing operations with sophisticated accountability systems in place.

Merritt added: “Medicare’s current 30-day payment cycle strikes the right balance between paying pharmacies promptly and protecting the integrity of the program.”

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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.

“Prompt Payment” Mandates Would Raise Costs Due to Pharmacy Fraud, Waste, and Abuse

Case Studies of Pharmacy, Fraud, Waste, and Abuse

PCMA “Bad Apples” Print Ad

PCMA: E-Prescribing is ‘Ready to Go’

(Washington, DC)— The issuing of final electronic prescribing (e-prescribing) standards in Medicare by the Centers for Medicare & Medicaid Services (CMS) further highlights the importance of requiring that doctors use the technology in Medicare, the Pharmaceutical Care Management Association (PCMA) said today.

“The time is now for e-prescribing in Medicare. Today will be remembered as a major step in the drive for health IT reform,” said PCMA President and CEO Mark Merritt. “E-prescribing is ready to go.”

CMS estimates that adoption of e-prescribing would reduce adverse drug events (ADEs); provide increased administrative savings to physicians and pharmacists; and enhance generic utilization. The e-prescribing standards in Medicare were developed and pilot-tested during a rigorous process with consensus from a variety of influential health care stakeholders. The final e-prescribing rule establishes standards for four types of information:

· Formulary and benefits;
· Medication history;
· Fill status notification; and
· Identification of health care providers.

In December, the bipartisan “Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007″ that would require e-prescribing in Medicare was introduced by Senate Finance Committee Members John Kerry (D-Mass.) and John Ensign, (R-Nev.). Companion legislation was introduced in the House by Representatives Allyson Schwartz, (D-Penn.) and Jon Porter, (R-Nev.). Both bills are supported by a broad coalition of consumers, unions, businesses, purchaser groups, and other prescription drug stakeholders.

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.” 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.

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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