E-prescribing, opioid issues, medication therapy management, pharmacy access addressed by Centers for Medicare & Medicaid Services.
"NACDS appreciates the commitment of CMS Administrator Seema Verma and her colleagues in helping to lead the collaboration that will be necessary to address the opioid abuse epidemic."
NACDS strongly supports a Senate letter sent to Health and Human Services (HHS) Secretary Tom Price and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma on the use of direct and indirect remuneration (DIR) fees.
NACDS emphasized its commitment to working with Congress, the Department of Health and Human Services and others to advance the delivery of affordable, accessible healthcare services.
Arlington, Va. – National Association of Chain Drug Stores (NACDS) President and CEO Steven C. Anderson, IOM, CAE, issued the following statement today, welcoming President-elect Donald Trump’s nominations of U.S. Rep. Tom Price (R-GA) as Secretary of Health and Human Services (HHS) and Seema Verma as Administrator of the Centers for Medicare & Medicaid Services (CMS):
“Collaboration is absolutely essential to maximize the potential of the healthcare delivery system, and to prevent policies that stifle it. NACDS looks forward to engaging completely in the ongoing work of developing and implementing solutions that benefit American patients and consumers.”
An article in the distinguished peer-reviewed health journal Health Affairs last week reported on an NACDS-supported study that found patients’ enrollment in Medicare Part D medication therapy management (MTM) programs varies according to the program’s eligibility criteria.
NACDS is always looking for ways to work with CMS to improve patient care and reduce overall all costs.
The study showed that enrollment rates in MTM programs among stand-alone prescription drug programs and Medicare Advantage drug plans averaged only 10 percent. In addition, enrollment variation across plans—from less than 0.2 percent to more than 57 percent—showed a direct correlation to the restrictiveness of the plans’ eligibility criteria. NACDS CEO Issue Update spoke with one of the authors of the study, NACDS Senior Economist Laura Miller, on the findings.
Q: The study shows plan sponsors have a great deal of latitude in setting eligibility requirements for MTM services under Medicare Part D. How does that latitude affect beneficiaries?
A: Plan sponsors can make eligibility restrictive or expansive—those with more restrictive criteria have fewer eligible and fewer beneficiaries getting MTM
Q: The study found that most Medicare Part D sponsors have chosen to provide MTM services to narrow segments of their enrollment pools. Why?
A: At least for prescription drug plans (PDPs), MTM services are a cost but neither PDP plans or Medicare Advantage plans are directly reimbursed by Medicare for the costs of providing MTM. Because financial incentives are not aligned with potential benefits of the services, plans are more inclined to restrict MTM services.
Q: How can CMS’s new Part D Enhanced Medication Therapy Management model improve the MTM program?
A: If CMS is able to align financial incentives for plan sponsors, they will use MTM any time it improves patient outcomes or reduces overall costs.
Q: Why is improving MTM benefits essential for patients, especially on a broader scale?
A: MTM has the potential to improve patient outcomes and reduce medical expenditures. The most common MTM service, an annual medication review, is particularly useful for patients taking multiple medications—to make sure they are not taking duplicative drugs, or drugs that interact with each other. Another important result of the annual medication review is to identify which, if any, [ READ MORE ]
Ever since the Federal Register published the final Covered Outpatient Drugs Final Rule (which directs pharmacy Medicaid reimbursement according to the average manufacturer price, or “AMP,” model) on January 21, 2016, NACDS has been evaluating the rule and determining appropriate actions.
The rule and its implementation must be viewed through the lens of its effects on patients’ access to vital medications and pharmacy services.
NACDS has done so according to two key principles that have guided the Association’s actions over nearly a decade related to this issue: that NACDS operates as a member-centric trade association, and that the rule and its implementation must be viewed through the lens of its effects on patients’ access to vital medications and pharmacy services. That was the spirit of NACDS’ initial statement on the final rule posted on January 21, the timeline of this issue’s decade-long history, the update that we provided on our consideration of the final rule, and various analytical and informational resources that we have provided along the way.
Having discussed the final rule extensively with the NACDS Policy Council, the NACDS Executive Committee and the NACDS Board of Directors – as well as with diverse NACDS members at the NACDS Regional Chain Conference and NACDS Annual Meeting – we wanted to provide an update on where we stand at this point on an issue that will continue to play out during the rule’s implementation.
First, it is clear that one of NACDS’ top priorities must be to actively monitor and analyze the implementation of the rule – including actions by state governments and by the Centers for Medicare & Medicaid Services (CMS). As states make legislative and regulatory changes in light of the final rule – to implement AMP-based federal upper limits (FULs), cost-based reimbursement for brands, and professional dispensing fee reimbursement – and as CMS considers related state plan amendments, vigilance will be essential to ensure these changes are conducive to patient access. As a result of advocacy by NACDS and the National Community Pharmacists Association, the final rule includes important provisions related to drug reimbursement and professional dispensing fees and it will be [ READ MORE ]
Arlington, Va. – The National Association of Chain Drug Stores (NACDS) applauds the Center for Medicare & Medicaid’s (CMS) inclusion of network adequacy standards—which would improve patient access to care in Medicaid and the Children’s Health Insurance Program (CHIP)—in the Medicaid and CHIP Managed Care final rule the agency released on April 21.
NACDS has consistently advocated for network adequacy standards that promote access based on patients’ needs, availability of care and providers, and utilization of services. In response to a request from CMS, NACDS submitted comments in 2015 recommending that “the final rule should include a framework that will serve as a tool to ensure that plans maintain beneficiary access to their current providers.” In addition to establishing a framework, NACDS said it hoped to help CMS “create standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide.”
“CMS’ decision to include a provision that ensures patients have access to pharmacy services is consistent with NACDS’ position on ensuring patients have continued access to care, which leads to better overall health outcomes and reduced costs,” said NACDS President & CEO Steven C. Anderson, IOM, CAE. “NACDS remains committed to working with CMS as it strives to advance and improve the healthcare system.”
Of note, the effective date of the rule is July 6, 2016, however the section specific to access to care is effective July 1, 2018. The final rule indicates that plans will not be held out of compliance with this requirement until July 1, 2018.
NACDS Speaks on Biosimilars at the Generic Pharmaceutical Association Annual Meeting
Medicaid AMP Issue Reflects Founding Vision of NACDS
