Pharmacy Provisions Intact in Health Care Reform Bill

The final health care reform bill that was approved by the House of Representatives late Sunday night could be signed into law as early as Tuesday. Although the long-term effects of the health care overhaul may take years to materialize, pharmacy advocates are lauding the bill’s inclusion of key pharmacy provisions they believe will reduce costs, improve patient outcomes, and advance the pharmacy profession.

The following 4 elements of the legislation, which passed by a vote of 219-212, are closely aligned to prior recommendations by the National Community Pharmacists Association (NCPA), the National Association of Chain Drug Stores (NACDS), and the American Pharmacists Association (APhA):

(1) Medicare reimbursement. The new bill reduces cuts to Medicare reimbursement for generic drugs and sets an upper limit of no less than 175% of the Average Manufacturer’s Price. Over time, the legislation will close the “doughnut hole,” beginning this year with a $250 rebate to Medicare patients who reach the coverage gap.

(2) PBM transparency. Pharmacy benefit managers (PBMs) who operate in the new health insurance “exchanges” will be required to disclose information about their practices to the benefit of payers, providers, and beneficiaries.

(3) DME accreditation. Most pharmacies will be permitted to sell Durable Medical Equipment (DME) to Medicare patients without undergoing a lengthy accreditation process.

(4) MTM services. Under the new legislation, grant funding will be given to support the development of Medication Therapy Management (MTM) programs.

Bruce T. Roberts, RPh, vice president and CEO of the NCPA, said today in a press release that the legislation is a boon for patients and community pharmacists. He called the measures “welcome steps towards improving the delivery of prescription drug services to patients across America.”

Steven C. Anderson, IOM, CAE, NACDS president and CEO, is encouraged by the recognition the bill grants pharmacists, but said continued vigilance is needed to monitor the progress of reform as it is implemented. “This in many ways is still the early stage of our campaign to advance pharmacy’s value and viability as the face of neighborhood health care,” said Anderson.

In his blog on the APhA Web site, Tom Menighan, BSPharm, MBA, echoed statements made by Roberts and Anderson. Although he expressed disappointment in the level of funding set aside for MTM programs, Menighan considers the bill a success, and acknowledged the dedicated efforts of pharmacists and allies that contributed to its passing.

Those efforts are far from completed, however, according to APhA's executive vice president. Concerning the future of pharmacy and health care reform, Menighan wrote, “We will have years of work ahead of us in the regulatory process to assure that our patients get the full benefit of our services. And pharmacists will have to step up and deliver.”