Medicaid | NACDS

Pharmacy Associations Highlight Pro-Patient Priorities Amid ACA Review Letter to president- and vice president-elect, congressional leadership emphasizes pharmacy access to improve patient outcomes and prevent higher healthcare costs

admin2016-12-19T09:29:52-05:00Categories: Press Release|Tags: Medicaid, Medicare, Reform, Reimbursement|

Washington, D.C. – In a letter to the new power structure in Washington, D.C., the National Association of Chain Drug Stores (NACDS), the National Community Pharmacists Association (NCPA), the American Pharmacists Association (APhA), and the National Alliance of State Pharmacy Associations (NASPA) have detailed steps necessary to leverage pharmacy patient care and prevent higher costs that result from untreated conditions.

“As the incoming Administration and Congress consider potential changes to the Medicare and Medicaid programs, we ask that you ensure that beneficiary access to pharmacies is protected. Policies that reduce local pharmacy access lead to poorer health outcomes, ultimately resulting in increased future healthcare costs,” the associations wrote to President-elect Donald Trump, Vice President-elect Mike Pence, Senate Majority Leader Mitch McConnell (R-KY), Senate Minority Leader Charles Schumer (D-NY), Speaker of the House of Representatives Paul Ryan (R-WI), and House of Representatives Minority Leader Nancy Pelosi (D-CA).

The letter highlighted:

the accessibility of pharmacists;
their role in boosting medication adherence, which relates to taking medications as prescribed;
the importance of maintaining patients’ choice of pharmacies;
the importance of assuring fair and accurate Medicaid pharmacy reimbursement, according to average manufacturer price (AMP)-based federal upper limits (FULs) that were enacted in the Affordable Care Act; and
opportunities to build on pharmacists’ vaccination success story by improving patient access to pharmacist services for underserved Medicare beneficiaries.

“Nearly all Americans (91%) live within five miles of a community pharmacy. As Americans’ most convenient and accessible healthcare provider, we look forward to continuing to work with you to ensure that Medicare and Medicaid patients can continue to receive cost-effective pharmacy services. As the demand for healthcare services continues to grow, pharmacists have expanded their role by collaborating with physicians, nurses, and other healthcare providers to meet patients’ needs,” the associations wrote.

While noting the opportunities that exist in newer pharmacist-provided services, the associations emphasized that jeopardizing pharmacy access for medication services threatens health outcomes and healthcare affordability.

The associations explained, “The importance of medication-related services and maintaining access to community pharmacists for the Medicare and Medicaid populations cannot be overstated. Improving medication adherence can help Congress achieve its goals of better managing care for Medicare and [ READ MORE ]

NACDS Welcomes HHS-OIG Final Rule That Allows Medicare, Medicaid Patients to Access Pharmacy Reward Programs

admin2016-12-14T13:33:09-05:00Categories: Press Release|Tags: HHS, Medicaid, Medicare, Medications|

Arlington, Va. – The National Association of Chain Drug Stores (NACDS) is welcoming a final rule issued by the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) that will allow pharmacies greater flexibility to extend their popular reward and loyalty programs to beneficiaries in government programs, including Medicare and Medicaid.

This is a very positive step forward for pharmacy patient care, and a further recognition by a government agency of the tremendous value of pharmacies as the face of neighborhood healthcare and of the expanded innovative programs that pharmacies provide.

The final rule reflects OIG’s acceptance of several of NACDS’ suggestions for important improvements to the final rules. NACDS had submitted formal comments to OIG during the development of the rule to express strong support for it in concept and to convey revisions that would be necessary for the rule’s workability.

“NACDS advocated for this rule, and worked constructively to help enhance it, because it will allow government program beneficiaries to enjoy access to programs voluntarily implemented by pharmacies which reduce healthcare costs, improve quality, and promote patient health,” said NACDS President and CEO Steven C. Anderson, IOM, CAE. “This is a very positive step forward for pharmacy patient care, and a further recognition by a government agency of the tremendous value of pharmacies as the face of neighborhood healthcare and of the expanded innovative programs that pharmacies provide.”

Federal laws have blocked participation by government-program beneficiaries in these initiatives offered by pharmacies, even though these initiatives have been enjoyed by other patients for many years. Programs vary in their specific designs. They often include cost-savings or other rewards for filling prescriptions or engaging in other health-promotion programs, such as health screenings or strategies designed to enhance medication adherence – or taking medications as prescribed.

“Pharmacy programs affected by the proposed rule reduce healthcare costs, both for individual patients and for the healthcare system as a whole. At the same time, these pharmacy programs promote access to prescribed medications that are essential to maintaining patient health and wellness,” NACDS explained in its comments submitted during the regulatory process.

“Failure to take medications [ READ MORE ]

Medicaid AMP: Vigilance Continues

sanderson2016-04-27T14:25:57-04:00Categories: Article|Tags: CMS, Medicaid, Reimbursement|

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 ]

Access to Care Provision Part of CMS’ Medicaid Managed Care Final Rule Final rule includes NACDS-backed provision to strengthen patient access to care

admin2016-04-27T11:41:54-04:00Categories: Press Release|Tags: CMS, Medicaid|

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.

The final rule marks the first major overhaul of the Medicaid and CHIP programs in more than a decade, and seeks to align key rules with other healthcare coverage programs. In order to strengthen access to care, the final rule requires states to establish network adequacy standards in Medicaid and CHIP managed care for key providers—including pharmacy—if their services are covered under the Medicaid contract, and the pharmacy network is consistent with the access standards for delivery networks.

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.