Pharmacy Groups Urge Changes to Costly Long-Term Care Mandate in Health Reform Bill
Source: National Community Pharmacists Association
Two leading independent community pharmacy advocates are urging Congress to consider more practical alternatives to legislation that would effectively mandate the purchase of expensive, unproven equipment intended to reduce the amount of wasted medication in long-term care settings.
The National Community Pharmacists Association (NCPA) and GeriMed, of Louisville, Kentucky, representing independent long-term care pharmacies, wrote a letter to US Senate Finance Committee Chairman Max Baucus (D-Montana) and House Energy and Commerce Committee Chairman Henry Waxman (D-California) regarding provisions in both the House and Senate-passed versions of healthcare reform.
Under the current proposed language, pharmacies participating in the Medicare Part D drug benefit and serving long-term care facilities would have to utilize specific dispensing techniques, such as weekly, daily, or automated dose dispensing. For most independent pharmacies, that would require the purchase of a costly technology system along with major changes to the work flow of the pharmacy.
“Reducing waste and promoting appropriate disposal of unused medications is very important,” the groups wrote. “However, small pharmacies may have more difficulty accessing or paying for this new technology, which has not yet been incorporated into the daily practices of independent pharmacies.”
Further, NCPA and GeriMed note that the new technology “has not even been thoroughly pilot-tested to see if it decreases waste of medications.” They also raise the possibility that each Part D plan could require a different dispensing technique with its own operating system. That may result in access concerns for long-term care pharmacy services in many rural areas, if pharmacies leave the field. Currently, 31% of all community pharmacies service a long-term care facility, the majority of which are located in areas with a population of less than 20,000 individuals.
In addition, the provision’s costs to taxpayers are masked by an incomplete Congressional Budget Office estimate. It failed to take into the account the additional time and dispensing fees that would result from providing medicines to residents of nursing homes and assisted living facilities on a more frequent basis.
To meet Congress’ goal of reducing the volume of unused medicine, while avoiding the problems noted above, NCPA and GeriMed offered lawmakers several options:
•Ease the equipment costs and other burdens of a shift to shorter dispensing cycles, such as through more frequent, full dispensing fees, tax credits, or direct financial incentives;
•Require prompt payment from Part D plans to pharmacies that serve long-term care facilities;
•Require the US Secretary of Health and Human Services to both consult with pharmacies and other stakeholders in developing standards and techniques to reduce waste as well as engage in a rulemaking process before the imposition of any uniform standards for these types of dispensing techniques;
•Test the new dispensing techniques to ensure their practicality for pharmacies and effectiveness at decreasing waste;
•Investigate other alternatives to reduce waste, such as credit and return of unused drugs and post-consumption billing;
•Identify and reduce pharmaceutical waste in Part D mail order dispensing.
One study estimates that mandatory mail order programs create 3.3 times more prescription drug waste than programs that allow the patient to use their local community pharmacy. Visit www.ncpanet.org/pdf/leg/uamsmailorderrprt.pdf to read the full study.
The National Community Pharmacists Association (NCPA) represents America's community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion healthcare marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA’s blog, The Dose, at http://ncpanet.wordpress.com.
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