NCPA, NACDS Fight to Preserve Patient Access to Needed DMEPOS

Julie Khani, Vice president of federal healthcare programs at NACDS

John Coster, PhD, RPh Senior vice president of government affairs at NCPA

The National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS), working together as the Coalition for Community Pharmacy Action (CCPA), have continued their efforts over the last few years to prevent the Centers for Medicare & Medicaid Services (CMS) from impeding patient access to valuable Part B durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) from community pharmacies.

Recently, CCPA achieved a major success in convincing Congress and the president to delay implementation of the deadline for pharmacies to obtain accreditation as a condition for new or continued participation in the Part B DMEPOS program. Because the president signed HR 3663 into law on October 13, 2009, pharmacies have until January 1, 2010, to become accredited.

Suppliers providing only Part B drugs and vaccinations do not have to meet the accreditation requirements, but they must meet the surety bond requirement, as must all pharmacies, in order to remain as a supplier in the Medicare Part B program.

CMS has indicated that, for pharmacies that have already stated they will only provide Part B drugs, but subsequently become accredited to provide DMEPOS, CMS will capture the accreditation information automatically from the accrediting organization. The supplier can then start to bill for all supplies and services for which they have been accredited as of the date of accreditation, without submitting a new 855S form to CMS.

In addition, CCPA has worked to obtain inclusion of 2 provisions in the House and Senate health care reform bills that would provide permanent, albeit limited, exemptions from the accreditation requirement.

The Senate Finance Committee bill includes a provision that exempts those pharmacies whose Medicare DMEPOS billings are <5% of pharmacy sales, have been enrolled as suppliers with no adverse final actions against them over the prior 5 years, and are willing to submit verification documentation. The secretary may determine more appropriate accreditation standards for pharmacies, as may be done for the other 17 types of medical professionals that are exempted from the accreditation requirements.

In the House TriCommittee bill, pharmacies that supply diabetic testing supplies, canes, and crutches are exempt from the accreditation requirements. In addition, those pharmacies that have been enrolled as DMEPOS suppliers for at least 5 years without any final adverse action would be exempt from the surety bond requirement. Accreditation would still be required for competitive bidding.

CCPA will continue to work with Congress and CMS to address the situation on a more permanent level, especially considering that passage of a health care reform bill may not occur before the extension deadline of January 1.

Finally, CCPA is continuing to address the position of community pharmacy in the DMEPOS competitive bidding program. CMS has indicated in a recent final rule that it will likely include retail diabetes testing supplies in future rounds of competitive bidding. CCPA is working to oppose this position as well as attempts to drastically reduce fee schedules for the DMEPOS supplies that community pharmacies provide to their patients.

We are working on all these issues to enable community pharmacies to continue to be able to provide vital Part B DMEPOS, and other supplies and services, to their patients.

The Coalition for Community Pharmacy Action (CCPA) is an alliance between the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA), which together represent more than 55,000 community pharmacies. CCPA leverages the support, effort, and infrastructure of NACDS and NCPA while engaging community pharmacy to participate and advocate on issues affecting the industry.