(Washington, DC)- The new law requiring electronic prescribing (e-prescribing) in Medicare is spurring physician groups across the country to adopt the technology.  The Texas Medical Association (TMA) is the first state medical organization to join a growing roster of national medical groups that are working to ensure all prescriptions are transmitted electronically.

“Increased adoption of e-prescribing is good for doctors and good for patients.  The recent e-prescribing Medicare law provides valuable incentives for those who would like to adopt this technology,” said Pharmaceutical Care Management Association (PCMA) President & CEO Mark Merritt. 

E-prescribing is successfully being used by more than 35,000 doctors nationwide.  PCMA led a diverse group of consumers, employers, unions, and medical professionals that supported passage of an e-prescribing requirement in Medicare. Supporters included among others: AARP, AFL-CIO, Consumers Union, Ford Motor Company, General Motors Corporation, and AT&T.

The Centers for Medicare & Medicaid Services (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. Health and Human Services (HHS) Secretary Mike Leavitt has previously stated 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.

“We applaud Senators Baucus and Conrad for helping advance the discussion about how best to improve quality through more objective information and to foster value-based purchasing.  We look forward to reviewing the Baucus-Conrad legislation in greater detail and working collaboratively with them and other stakeholders in this area.

“PBMs have been at the forefront of efforts to bring more measurement, accountability, and real-time information to the health care system.  PCMA believes comparing the clinical effectiveness of competing drug therapies is an important tool in promoting value-based purchasing.  Pharmacy benefit managers have led the way with pharmacy & therapeutics (P&T) committees and a wide range of proven utilization tools-including multi-tier formularies and step therapy-to ensure patients have access to cost-effective and clinically proven prescription drugs.”

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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)— Testifying today before the House Oversight and Government Reform Committee, Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt reported how Medicare prescription drug plans (PDPs) and the pharmacy benefit managers (PBMs) who administer them are generating broad access, driving deep discounts on prescriptions for America’s seniors and disabled beneficiaries in Part D, and reining in overall program costs.  In addition, Mr. Merritt offered the Committee additional policy options for improving Medicare Part D.

“Working within the competitive Part D framework, PBMs offer Medicare and its beneficiaries value by using proven tools and strategies that both rein in drug spending and provide a high-quality prescription drug benefit,” said Mr. Merritt.  “These tools—pioneered by PBMs—include increasing generic utilization, improving formulary compliance rates, and encouraging the use of lower-cost delivery channels, such as the mail-service pharmacy option.”

As part of his testimony, Mr. Merritt urged policymakers to consider other options to increase savings and access for Medicare Part D beneficiaries, including:

• Establishing a clear regulatory pathway for biogenerics;
• Building upon the groundbreaking new e-prescribing incentives that were just enacted as part of the “Medicare Improvements for Patients and Providers Act”; and
• Taking a closer look at the six classes of clinical concern and the associated cost implications on drugs used by dual eligibles.  This policy does not improve access but does make it difficult for PBMs to negotiate rebates for drugs in those classes which can account for more than 40 percent of dual-related spending.

In Part D, PBMs and plan sponsors have reduced overall program costs by 30 percent below government projections, offered beneficiaries lower-than-expected premiums, and generated high levels of generic utilization, while providing broad choice of drugs and access to over 60,000 pharmacies.  In addition, overall savings of PDPs in Part D are also comparable to levels achieved by PBMs in the Federal Employees Health Benefits Program (FEHBP), according to analysis conducted by PricewaterhouseCoopers (PwC).

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“The inclusion of an e-prescribing requirement in Medicare is a major victory for America’s seniors.  From a patient’s perspective, e-prescribing is the most important issue in the Medicare bill because it saves lives and saves money.  This is a historic step forward for e-prescribing as the new requirement in Medicare will now lead to broader adoption of overall health care information technology.

“We are also pleased that both the effective date of the AMP payment cut as well as the date for publication of AMP data have been delayed until September 2009.

“However, PCMA continues to oppose other special interest provisions which would pay independent pharmacists twice as fast as all other Medicare providers.  This will increase costs and provide no added benefit for seniors.”

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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.

Creation of Clear Regulatory Pathway Would Also Lower Total

Expenditures for Biologics by $25 Billion over Ten Years

(Washington, DC)— The Congressional Budget Office (CBO) today released a cost analysis finding that the creation of an abbreviated pathway for follow-on biologics—or biogenerics—would save the federal government $6.6 billion over ten years and lower total expenditures for biologics by $25 billion over the same time period.

“For a quarter century, generic versions of chemical drugs have saved consumers and payors billions of dollars.  Now, CBO has confirmed that giving FDA additional authority to approve generic versions of biologics will save billions more,” said PCMA President and CEO Mark Merritt.  “Even greater savings would be available if Congress simply applied to biologics the Hatch-Waxman standards that are currently used to approve generics for chemical compounds.  It would be helpful if some provisions in the bill—such as ‘evergreening’—which unnecessarily delay the entry of biogenerics were reconsidered.  CBO acknowledges that the ‘evergreening’ issue will present significant problems beyond the ten-year scoring window.”

CBO estimates that:

• Enacting S. 1695 would reduce total expenditures on biologics in the United States by $25 billion over the 2009- 2018 period.

• Enacting the bill would reduce budget deficits (or increase surpluses) by a total of $6.6 billion over the 2009-2018 period.

Unlike conventional drugs, there is no clear regulatory process where biogenerics can be approved by the FDA.  PCMA was joined by a number of influential consumer, employer, and insurer groups who endorsed the “Access to Life Saving Medicine Act of 2007,” bipartisan legislation that seeks to create a clear regulatory pathway for 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.

(Washington, DC)—As policymakers consider what to include in the final Medicare package, they face the decision of either supporting costly Medicare “prompt pay” requirements for pharmacies or postponing the Average Manufacturer Price (AMP) pharmacy reimbursement cuts in Medicaid which would ultimately harm both pharmacies and consumers, the Pharmaceutical Care Management Association (PCMA) said today. 

“Now that we’re in the endgame, Congress must choose between a reasonable AMP delay and a new policy to pay drugstores twice as fast as every other Medicare provider,” said PCMA President and CEO Mark Merritt.  “Delaying AMP is supported by a broad coalition of pharmacists, PBMs, and insurers.  ‘Prompt pay’ has no such support and would undermine the affordability and integrity of the Medicare program.”  

PCMA joined a group representing almost every segment of the pharmacy supply chain who signed a letter to Congressional leaders urging passage of legislation that will postpone the AMP payment reductions that threaten to devastate retail pharmacies and their low income patients.  Those signing the letter included:

• American Pharmacists Association
• Food Marketing Institute
• Generic Pharmaceutical Association
• Healthcare Distribution Management Association
• National Alliance of State Pharmacy Associations
• National Association of Chain Drug Stores
• Pharmaceutical Care Management Association

Medicare prescription drug plans (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.

The independent drugstore lobby partnered to create its own drug plan—Community Care Rx (CCRx)—which pays claims in 30 days—twice the length of time as the 14 day mandate in their own bill.  A link to the payment schedule for “one of the nation’s top Medicare Part D prescription drug plans” is provided. 

Three separate but remarkably consistent studies—including the drugstore lobby’s own study—highlight that PBMs are paying claims on time.

• Grant Thornton study (the drugstore lobby’s own study) that shows pharmacies are being paid within 30 days (See Page 15 for findings on average payment time).  
• Part D claims are being paid within 21-25 days, according to the Centers for Medicare & Medicaid Services. 
• Part D claims are paid within 23 days, according to a PricewaterhouseCoopers (PwC) study.

To highlight the costs associated with the independent drugstore lobby’s agenda, PCMA recently released a series of new prints ads.  One print ad warns policymakers that other Medicare providers—including doctors and hospitals—would likely demand the “same prompt-pay deal” next year if Congress requires pharmacists to be paid twice as fast in Medicare.   An additional print ad 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.

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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) released a new ad today warning policymakers that other Medicare providers-including doctors and hospitals-would likely demand the “same prompt-pay deal” next year if Congress requires pharmacists to be paid twice as fast them in Medicare.

“Paying one group of Medicare providers twice as fast as all the others will create a ‘stampede’ of other providers demanding the same treatment next year,” said PCMA President and CEO Mark Merritt.  “This will lead to billions in new Medicare costs, make fraud, waste, and abuse tougher to detect, and offer no benefit whatsoever to seniors.”

Meanwhile, the drugstore lobby’s own study[1] confirms that they are already being paid within 30 days. Three separate but remarkably consistent studies highlight that PBMs are paying claims on time.

• Grant Thornton study (the drugstore lobby’s own study) that shows pharmacies are being paid within 30 days (See Page 15 for findings on average payment time). 
• Part D claims are being paid within 21-25 days, according to the Centers for Medicare & Medicaid Services. 
• Part D claims are paid within 23 days, according to PricewaterhouseCoopers (PwC).

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 $3.3 billion over the next decade according to a new study by PwC.   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.

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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.