http://www.ncpanet.org/blog/ Executive Update on the Web en-us Nucleus CMS v3.22 ? Weblog http://backend.userland.com/rss http://www.ncpanet.org/blog//nucleus/nucleus2.gif http://www.ncpanet.org/blog/ http://www.ncpanet.org/blog/index.php?itemid=297 Dear Colleague,

Health care reform legislation may be on life support, but NCPA is making progress to ensure that key components of it critical to community pharmacy survive. A case in point: DME accreditation.

While we originally thought that pharmacies that are not accredited would have to step down or voluntarily terminate by today, Feb 12, earlier this week we received an indication from CMS that pharmacies have until the end of the month before the agency will require them to take action with respect to stepping down or voluntarily terminating from Medicare Part B DMEPOS. Pharmacies that are not accredited will likely be receiving letters in the mail very soon from the National Supplier Clearinghouse that will describe the options.

Also, we are pleased to report that a bill being considered by the Senate does include a permanent DME accreditation exemption for pharmacies that meet certain criteria. We have worked closely with Senate Finance Committee Chairman Max Baucus (D-Mont.) and ranking GOP member Charles Grassley (R-Iowa) on this issue, which was included in the now stalled health care reform legislation. I made our case to the Capitol Hill community at large in an op ed published in The Hill Wednesday.

We are hopeful that we can get the permanent exemption enacted soon. Ideally, the bill would be passed by March 1 so pharmacies that are not accredited would not have to take action to step down, but it's possible that Congress will not meet that deadline. Washington's back-to-back blizzards coupled with a previously scheduled congressional recess next week make the legislative schedule uncertain at this point.

Here's the information we received from CMS: The National Supplier Clearinghouse will notify DMEPOS suppliers who have not initiated the accreditation process or who are in the midst of accreditation process regarding their enrollment options. In short, DMEPOS suppliers who are not accredited by a CMS-approved accreditation organization will need to discontinue furnishing accredited services on or after March 1, 2010 until they are accredited. In addition, these suppliers will need to become accredited by March 1, 2010, or elect to: (1) Step-down to furnish non-accredited products and services, or (2) Voluntarily withdraw/terminate from the Medicare program.*

* Note: DMEPOS suppliers who make the business decision to voluntarily withdraw/terminate from the Medicare program will need to reapply to furnish accredited services in the future.

I'm cautiously optimistic that the accreditation exemption will be enacted soon, and that Congress also will look favorably on a number of our other top priorities including an AMP fix, PBM transparency, and MTM expansion.

Regards,

]]> General http://www.ncpanet.org/blog/index.php?itemid=297 Fri, 12 Feb 2010 06:00:00 -0400 http://www.ncpanet.org/blog/index.php?itemid=295
We're been getting widespread anecdotal reports for weeks now that independents can't get generic Valtrex (valacyclovir) through wholesalers, but the mega-chains are buying it directly from Ranbaxy, the manufacturer. (If you have evidence of this, please send it to me).

We were growing so concerned that we wrote to Ranbaxy officials last Dec. 17 to protest any effort to put large chains first and freeze out independents. Several wholesalers of varying size told NCPA they don't have access to valacyclovir at all. So it's possible that Ranbaxy has, in fact, struck direct-to-pharmacy deals with some large chains. Many of you may remember that the company employed the same strategy for selling its generic version of Augmentin some years ago.

Ranbaxy certainly is no stranger to more recent controversy. In late December, the FDA chided the company over its manufacturing practices and, in 2008, the agency blocked Ranbaxy from importing 30 different generics.

For more than six weeks, all we got from Ranbaxy about our letter was silence. Last week we tried again, and this week our friends at the Pharmacists Society of the State of New York, Inc. (PSSNY) also contacted Ranbaxy, India's largest pharmaceutical manufacturer in which Japanese drug maker Daiichi Sankyo owns a controlling stake.

A couple of days ago, Ranbaxy finally, belatedly responded to our letters. The company cited a shortage of raw materials, including the active pharmaceutical ingredient, as the primary factor behind its inability to meet customer demands during the 180-day exclusivity period it was awarded by the FDA for being the first generic drug application approved. (I think it's noteworthy that the FDA does not have valacyclovir on its official list of drugs in short supply. The list will cite a lack of raw materials if that is a reason for a shortage.)

Ranbaxy's response pointedly did not address whether the company struck a direct-to-large-chain distribution deal. Its answers also indicated a lack of awareness that, for some U.S. patients, an independent community pharmacy is the only health care provider for many miles around.

We are exploring several legal, regulatory, and legislative routes to address this unfair situation that really hits patients and payers and pharmacies. That's who we're going to bat for.

Another point is that the PBMs know full well what's going on. They should allow independents to bill for the brand if a generic is not available to them.

Regards,
]]> General http://www.ncpanet.org/blog/index.php?itemid=295 Fri, 5 Feb 2010 13:05:44 -0400 http://www.ncpanet.org/blog/index.php?itemid=293
Inevitably, Haiti is fading from page one in our newspapers and the top story on the evening news. The enormous spike in charitable contributions is falling. The critical needs of the Caribbean nation, however, will endure for months, if not years, to come.

Tragic as the situation in Haiti remains, except for its scale it is not unique. Countless other humanitarian needs span the globe unnoticed or forgotten. Many are closer to home, though seemingly harder to find or easier to overlook.

Look for them.

Look for them if you really want to help, to contribute time, talent, or treasure. Figure out in advance what you can and would be willing to do. It's an intriguing notion to slip on a safari jacket and parachute into the danger zone, but it's unrealistic and harmful for all.

If you really can set aside your business and family on hours notice and deploy to a natural disaster like a hurricane or earthquake or a man-made one like a bioterrorist strike for a couple of weeks, you need a personal plan and special training. (Read about one NCPA member's experiences in Haiti in The Dose and the government's National Disaster Medical System.) There are also less fraught assignments such as regular medical missions sponsored by church groups or other non-governmental organizations to serve needy people overseas. There are plenty of local clinics that regularly could use a pharmacist, and NCPA student chapters are active in community outreach projects that would welcome a pair of experienced hands.

Search for the opportunities now. There are many. Know what you're committing to from cool reflection rather than the well-intentioned passion of the moment. We'll all be glad you did.

If anyone has suggestions or experiences they'd like to share on volunteerism, please send them to me.

Regards,

]]> General http://www.ncpanet.org/blog/index.php?itemid=293 Fri, 29 Jan 2010 12:22:51 -0400 http://www.ncpanet.org/blog/index.php?itemid=291
"Take a deep breath." That's the best advice coming out of the capital this week about the fate of health care reform legislation. Close behind is, "Don't believe any predictions until you've taken that deep breath—or three."
Republican Scott Brown's upset win in Massachusetts Tuesday for the Senate seat held by Edward Kennedy for 47 years ends the Democrat's 60-vote supermajority—the number needed to halt a filibuster. Right now, congressional Democrats and President Obama are weighing their options.

To get around the filibuster hurdle, the House could just accept word-for-word the bill that passed the Senate in December 60-39 on a party line vote. From NCPA's perspective, that could be described as "a half a loaf is better than none." It would provide a Medicaid generic drug reimbursement formula that sets the FUL at 175% of a weighted AMP and includes an exemption from the Medicare Part B accreditation requirements for pharmacies that get no more than 5% of total prescription sales from DME, such as diabetes testing supplies.

The PBM transparency requirements in the Senate bill could be strengthened by combining them with those from the House-passed version as would the MTM provisions. Ratifying the Senate plan also would preclude House-Senate negotiations to increase the 175% AMP multiplier. Just last week we held a conference call for reporters with two community pharmacy stalwarts, Reps. Marion Berry (D-Ark.) and Jerry Moran (R-Kan.), who said they were working with the negotiators to get the figure closer to 300%.

One big question is would, or could, the House swallow the Senate version whole even with the promise of separately enacting remedies to fix the parts it doesn't like? (There are some observers who doubt, given the near panic mode gripping a sizeable number of Democratic lawmakers here, that the House today could even pass its own health care reform bill that squeaked through 220-215 last November.)

There also is talk of a scaled-down version with less coverage and cost, breaking the package into individual bills, or going back to the drawing board entirely.

So where does that leave NCPA? To say we're "closely monitoring the situation" wouldn't do justice to what our government affairs team is doing and what we have accomplished in this past year.

We know that community pharmacists are critical component of the health care team and have the vast potential to improve care and reduce costs. That has been and will continue to be our message. We will continue to advocate for those provisions that we have fought to have included in the bills and also to produce desirable outcomes for those provisions, such as the LTC "short cycle" provision, that could be helpful or detrimental depending on how they are implemented.

We're in this fight for the long haul, and it certainly looks like that's what it will be.

Another long-haul prospect is the tragedy in Haiti. In e-News Weekly next Tuesday, we're going to have some first-person accounts and pictures from an NCPA member who deployed to Port au Prince with a U.S. emergency medical response team. I'm sure many of you would like to help and we'll include information about National Pharmacy Response Teams that can be activated for service to cope with medical catastrophes around the corner or the globe.

I know there are many worthy charities funneling aid to Haiti, and I'm not trying to play favorites, but the situation is so dire, I'd like you to consider right now making an instant contribution via your cell phone. You can make a $10 one to the Red Cross by texting the word "Haiti" to 90999, which automatically adds a $10 pledge to your bill.

Regards,

]]> General http://www.ncpanet.org/blog/index.php?itemid=291 Fri, 22 Jan 2010 10:39:49 -0400 http://www.ncpanet.org/blog/index.php?itemid=289
On Capitol Hill it's crunch time for health care reform as negotiations between House and Senate Democratic leaders and White House officials, including President Obama, seem to be heading to a conclusion. Details, especially on the "smaller" provisions, are scant so far. But among those smaller provisions are a number of critical importance to community pharmacists and their patients.

Heading the list is getting an adequate fix to Medicaid's reimbursement formula for generic drugs. To keep getting the word out about concerns, we held a media briefing earlier this week to update reporters on where things stand and to demonstrate the strong, bipartisan support there is among the rank-and-file in Congress for an equitable reimbursement formula. Following is an edited recap of the briefing from our new blog, The Dose; a recording of the call is available here.

Two stalwart advocates for community pharmacy joined us: U.S. Reps. Marion Berry (D-Ark.) and Jerry Moran (R-Kan.), both members of the Congressional Community Pharmacy Caucus.
John Coster, NCPA's Senior Vice President for Government Affairs, set the stage:

• Independent community pharmacies derive 90% of their revenue from filling prescriptions, a much higher rate than large, national chains or grocery-based pharmacies.
  
• The average independent fills about twice as many Medicaid prescriptions as large, traditional chains do; in some cases it can be up to 50% of their prescription business.
  
• Medicaid patients in rural areas are more likely than not getting their prescriptions filled at an independent pharmacy.
  
• Medicaid's cuts stem from its shift to an average manufacturer price (AMP) reimbursement formula, a policy that has been blocked by a 2007 injunction successfully sought by NCPA and the National Association of Chain Drug Stores. The Government Accountability Office has twice estimated that those cuts would reimburse pharmacies well below even their drug acquisition costs.
  
• Final health reform legislation should contain nothing short of the Senate's proposal to set federal upper limits for reimbursement at no less than 175%. That would encourage maximum utilization of lower-cost generic drugs while keeping community pharmacies in the program. Anything less, such as the House's proposal, could significantly impact patient access to community pharmacies.
  

Reps. Berry and Moran have written to the leadership in the Congress, asking the House to agree to the Senate version. The two Congressmen renewed that call and testified to the importance of community pharmacies and the services they provide.

"This is an issue that brings us together as Republicans and Democrats and urban and rural members," said Rep. Moran. "Who I'm really advocating on behalf of are the consumers, the patients, those who need the pharmacist services in communities across Kansas and across the nation.

"There are eight counties in Kansas that have no pharmacy at all," he added. "This is one of the reasons that it is so difficult to maintain a community pharmacy."

Pharmacist Brian Caswell of Wolkar Drug in Baxter Springs, Kan., NCPA's third vice president, affirmed that point. Wolkar Drug serves rural Cherokee County and Medicaid makes up around 30% of its prescription business.

He said pharmacies in Kansas are already absorbing reduced reimbursement due to the average wholesale price (AWP) rollbacks resulting from the First DataBank settlement and a 10% Medicaid cut the governor implemented.

"If the reimbursement rate is too low for me to be able to participate, I'm going to have to turn away around a quarter of the number of people that come into my door, which is devastating," he added. That would force him to cut back employees, minimize operating hours or possibly close the pharmacy. "One more hit on Medicaid reimbursement is, I think, unsustainable, especially with the magnitude of what this one could be."

"Without this fix, there's going to be a lot of pharmacies, like myself, that have heavy Medicaid populations—we're not going to be able to continue to service those patients," Caswell concluded. "I'm concerned where they could go after that and whether or not they're going to have continued pharmacy services in order to keep them out of the hospital settings or seeing their physicians even more because they won't have the pharmacy services that they need and the consulting services that we provide. Again, in the state of Kansas, where we are a very rural state, many people see a pharmacist as their only health care provider and they have to drive so far to see a physician."

NCPA is going to continue to fight for an AMP fix and the other community pharmacy provisions in the pending health care reform bill. Read our letter
to House Speaker Pelosi and Senate Majority Leader Reid on all our recommendations. Please forward it to your representative and senators and ask for their support.

Regards,

]]> General http://www.ncpanet.org/blog/index.php?itemid=289 Fri, 15 Jan 2010 12:02:07 -0400 http://www.ncpanet.org/blog/index.php?itemid=287
We're preparing to launch a worthy initiative next week that potentially can bring new customers to your pharmacy while protecting the environment: a medication return program.

Patients and politicians are increasingly looking for an answer to the improper disposal of an estimated 125,000 tons of unused prescription drugs each year. An investigation by the Associated Press last year found traces of a wide spectrum of pharmaceuticals in the drinking water of at least 41 million Americans. True, the impact is unknown but it cannot be good. Additionally, unused, unneeded medications lying around the household present the potential for misuse or an accidental poisoning.

The NCPA return initiative will give members the tools to give their patients the ability to do something about this growing problem.

To commemorate Earth Week 2010 (April 17-24, the 40th anniversary of the Earth Week environmental movement), NCPA is offering members a healthy discount on a return program from a well-respected company plus free shipping. Final details should be available next week, hopefully in time for the Jan. 12 edition of e-News Weekly.

But I can tell you that along with a member-only discount, you'll get free access to customizable flyers, counter cards, bag stuffers, and posters to promote your collection activities. The cost of the container and printing bag stuffers and other promotional materials can be done for less than $100—a small price to pay for a program that consumers want and can help your community.

Some pharmacy return programs have found that more than 40% of the people coming in to drop off their unwanted drugs were not regular customers. What a great way to get potential patients into your pharmacy by showcasing community leadership and concern. NCPA members can look at some successful return program efforts in the online archives of America's Pharmacist for March 2009.

Alone we can't save the planet or every person who our pharmacies touch. But we can help. We can keep some medicines out of the water we drink, the lakes we swim in, the rivers we fish in. We can help a family avoid a heart-wrenching tragedy.

Our convention this year is in Philadelphia whose favorite son Benjamin Franklin noted, "Individual endeavor can change the course of history for the better." That is our call. I'd like to think we can make a difference.


Regards,


]]> General http://www.ncpanet.org/blog/index.php?itemid=287 Fri, 8 Jan 2010 12:30:28 -0400 http://www.ncpanet.org/blog/index.php?itemid=285
This holiday season there is much that community pharmacy can be thankful for—or at the very least encouraged by. I certainly know times are tough for the 15 million unemployed Americans, and there are pharmacy owners who are struggling, too. I know too that I'm a perpetual optimist, but sometimes the problems do seem to over shadow the progress.

For one thing, Americans trust pharmacists. They have for a long time and it's no small accomplishment in today's 24/7 media maelstrom of facts, opinion, and gossip.

In the annual Gallup poll of public attitudes on honesty and ethics released this month, 66% of Americans said pharmacists have either very high or high ethical standards. That rating puts pharmacists second only to nurses, who led with 83%.

All of us should be very thankful that 3.8 new independent pharmacies have been opening daily through the first eight months of this year. That's an amazing statistic, considering that this is the worst economic climate since the Great Depression.

But if you've ever seen the energy, commitment, knowledge, and enthusiasm of the pharmacy students attending our annual convention you'll understand why. Our student chapters, number of entrepreneurial courses, ownership workshop attendance, and the quantity and quality of the entries in the Pruitt-Schutte Business Plan competition continue to grow. I know we've experienced net losses in overall numbers in recent years, but I'm hopeful that when the books are closed for 2009 we'll come out ahead.

Our work has paid off with the FTC launching a full-scale investigation of the business and privacy practices of CVS Caremark. The examples that you have sent us have been invaluable. (Keep new outrages coming. Check out the latest ones on The Dose.) Without them, there likely would have been no investigation.

I can't predict what if anything the FTC will find and do and what the impact on community pharmacy will be. But I know there were a lot of skeptics when we began this effort a year ago who thought the FTC would never reexamine the merger it had just approved in 2007.

Another area of uncertain outcome is health care reform. But like at the FTC, community pharmacy has had the opportunity to make its case at the highest level.

In the past three weeks alone, we've met with the following House leaders on health care reform:

• Majority Leader Steny Hoyer of Maryland
  
• Majority Whip Jim Clyburn of South Carolina
  
• Republican Leader John Boehner of Ohio
  
• Energy and Commerce Committee Chairman Henry Waxman of California
  
• Energy and Commerce Committee Ranking Member Joe Barton of Texas
  
• Ways and Means Committee Ranking Member Dave Camp of Michigan
  

We've also met with Senate Finance Committee Ranking Member Charles Grassley of Iowa on health care reform and Rep. Aaron Schock of Illinois on Caterpillar's deal with Wal-Mart and Walgreens that excludes most independents.

Again, I can't predict what the outcome of the reform debate will be—but at least neither can anyone else. We have and we will continue represent the interests of community pharmacists and our patients until the last vote is cast.

Just this week, we and NACDS worked to get 16 bipartisan representatives to write House Speaker Nancy Pelosi to urge her to support a higher federal upper limit for Medicaid generic drugs than the 130% of weighted AMP passed by the House in its reform bill. The current Senate bill calls for no less than 175% of weighted AMP.

There is talk here of Senate votes on Christmas Eve. Hopefully it won't come to that. I don't expect to be writing Executive Update Dec. 25 or Jan. 1 so I can spend more time with our first grandchild. If events warrant, however, NCPA will keep you informed. Have a happy and safe holiday.

Regards,


]]> General http://www.ncpanet.org/blog/index.php?itemid=285 Fri, 18 Dec 2009 11:47:29 -0400 http://www.ncpanet.org/blog/index.php?itemid=283
We received some very important news from the Pentagon yesterday when it issued an interim final rule designating pharmacies as providers for H1N1, seasonal flu, and pneumonia vaccinations under its TRICARE program, which covers 9.5 million patients. The policy change is effective immediately. It is expected to be fully implemented later this month, and brings TRICARE in line with other insurers that have covered pharmacist-administered vaccinations for years.

This is a shining example of how community pharmacists can help produce better health outcomes more conveniently and at lower cost while delivering appropriate preventive care services. Hopefully this decision will start more big insurers and payers—and pharmacists, too—thinking and remembering that pharmacies are more than just for prescriptions.

I noticed this week that some $500 million in stimulus funding was being awarded to construct or renovate 85 community health centers. What about the 22,700 independent community pharmacies coast-to-coast? They can and should be thought of as community health centers, too.

Vaccinations are a good first step. Pharmacists now can provide them in every state. Get the necessary training and get on board. We've had a good relationship recently with Merck and its adult vaccination program.
(Incidentally, NCPA will also be responding to TRICARE's request for comments on additional vaccines that should be covered through community pharmacies.)

High blood pressure, bone density, cholesterol, liver function, blood glucose, and hemoglobin A1C are just a few of the screenings and testing that can be provided at community pharmacies, regularly or at special health fairs. As you know, a number of the chains are pursuing the health center idea by opening walk-in clinics in their pharmacies, usually with nurse practioners. I had a doctor coming to my pharmacy on a regular schedule for a number of years, which fit nicely with my compounding practice. Many pharmacies may not have the space or the necessary doctor interest, but it's worth considering, especially with all the buzz about coordinated care, the medical home model, and the importance of pharmacists providing medication therapy management in the health care reform bills.

The point I'm trying to make is that we all know prescription margins are going to remain under pressure for the foreseeable future. To my mind, we've got to be seen as more than only purveyors of a product—no matter how important that product is.

I know vaccines are a product, too, but I really believe most people correctly see providing them as a service. The more we are seen as knowledgeable providers of health services, including prescription services, the better off we'll be.

Regards,

]]> General http://www.ncpanet.org/blog/index.php?itemid=283 Fri, 11 Dec 2009 11:37:36 -0400 http://www.ncpanet.org/blog/index.php?itemid=281
This morning I had separate face-to-face meetings with two of the most influential legislators in Congress: Reps. Steny Hoyer (D-Md.), the House majority leader, and Henry Waxman (D-Calif.), chairman of the House Energy & Commerce Committee. Hoyer is the second-ranking Democrat in the House after Speaker Pelosi. Waxman leads one of the three House committees that crafted the health care reform bill (H.R. 3962, the Affordable Health Care for America Act) that passed the House last month. Accompanying me in the meeting with Hoyer was Howard Schiff, executive director of the Maryland Pharmacists Association, and John Coster, NCPA sr. v.p. for government affairs.

First off in both meetings, we thanked them for their current and past support of independent community pharmacy. Then we asked for some more.

On accreditation, we were encouraged that they both had backed efforts earlier this fall by Rep. Zach Space (D-Ohio) to secure an extension of the deadline by which pharmacy suppliers of Medicare Part B DMEPOS had to obtain accreditation. Space's bill, which became P.L. 111-72, pushed the deadline from Oct. 1, 2009 to Jan. 1, 2010. (Sens. Tester and Grassley helped get it through the Senate.)

Both the House health care reform bill and the Senate's (H.R. 3590, the Patient Protection and Affordable Care Act) include an accreditation exemption for pharmacies under some circumstances. However, enactment of any health care reform measure by Jan. 1 is unlikely.

This morning, we told Hoyer and Waxman of our concern that CMS will start revoking pharmacy billing numbers if they have not been accredited by Jan. 1. We suggested to the lawmakers that they consider an extension to April 1, 2010 to avoid having any pharmacies lose their Medicare billing privileges before, we hope, Congress changes the accreditation requirements in the final health care reform legislation. They indicated that our issue would be included in "extender bills" needed in several areas before health care reform is enacted.

We also expressed a preference for the approach taken in the Senate bill: an exemption from accreditation for any pharmacy with Medicare DME sales 5% or less of their total Medicare sales. I think that is cleaner than the path that passed the House—waiving the accreditation requirements for the sale of diabetes testing supplies, canes, and crutches.

A tougher task concerns AMP. Both the House and Senate reform bills attempt to fix the unfair and potentially devastating Medicaid reimbursement scheme wrought by the Deficit Reduction Act of 2005 and a CMS regulation attempting to implement it. Our lawsuit with NACDS has successfully blocked implementation for the last two years.

The House bill calls for FULs for generic drugs to be calculated at 130% of a weighted average AMP. The Senate approach uses a multiplier of 175%.

Both are an improvement. Neither is sufficient, however, in our judgment. We noted that in the last Congress we supported H.R. 3700, sponsored by Rep. Frank Pallone (D-N.J.), chairman of Waxman's health subcommittee. That bill would have set the reimbursement rate for generics at 300% of a multiple source product's weighted average AMP.

We told the lawmakers (and Speaker Pelosi, too, in an earlier letter) that the 300% figure is necessary because in most states the Medicaid dispensing fees are well below our costs of dispensing.

We know that this percentage may be unrealistic in today's economic environment, but that we remain concerned that reimbursement for generics at no more than 130% of the weighted average AMP, combined with the low dispensing fees paid by states, could have us dispensing drugs at a loss, and so could 175%.

I think we made a compelling case. They seemed to agree, and Waxman said he would take a close look at AMP when he'll be a lead figure in reconciling the House version with whatever passes the Senate.

Overall I'm encouraged, but with the Senate debate expected to last at least until Christmas, we have a long way to go.

Regards,


]]> General http://www.ncpanet.org/blog/index.php?itemid=281 Fri, 4 Dec 2009 17:57:15 -0400 http://www.ncpanet.org/blog/index.php?itemid=279
Last Monday brought two very positive developments at the FTC regarding its investigation of the CVS Caremark merger and oversight of PBMs in general. Namely, NCPA leadership met FTC Chairman Jon Liebowitz about the investigation and, later, President Obama nominated two new commissioners, including Julie Brill, a staunch consumer advocate who has kept a keen eye on PBMs over her distinguished public service career.

Along with other key NCPA staff and outside counsel, I met with Chairman Leibowitz, Deputy Director for Healthcare Enforcement Brad Albert, Advisor to the Chairman Mike Kades, and others.

The meeting was a great beginning to a new, hopefully even more productive, relationship with the FTC. Chairman Leibowitz clearly gets it. His father-in-law was a professor of pharmacology and his mother-in-law was a pharmacist.

I emphasized in detail why community pharmacy makes a difference in the market to consumers. We serve in underserved areas, provide a much higher level of service, and have a strong ties and commitment to the community.

I also discussed how some PBM practices routinely disadvantage patients, who often wind up turning to their community pharmacy to address problems. Community pharmacies are laboratories of innovation and accessible pillars of our health care system, not just purveyors of a commodity.

We discussed how community pharmacies are critical to trying to solve the problem of ineffective drug use, especially through projects such as the Asheville project.

We thanked the FTC for its investigation of CVS Caremark and for our May meeting with 80 community pharmacists and two patients. We reiterated that CVS Caremark's conduct raises very serious concerns.

We also asked the FTC for greater attention to anticompetitive conduct by PBMs; to reconsider the benefits of PBM transparency legislation, as exemplified by provisions in the House and Senate health care reform bills; greater consideration of the need for pharmacies to collectively negotiate with PBMs; and more thorough review of PBM mergers to consider the harm they pose to patients and robust pharmacy competition. I was so enthusiastic after the meeting that I wrote about it almost immediately in our new blog, "The Dose," where we also have links to a terrific TV exposeŽ on CVS Caremark and our response to a misleading article in USA Today on alleged pharmacist price gouging on compounding Tamiflu.

NCPA is also greatly encouraged by President Obama's nomination of Julie Brill to serve as an FTC commissioner. Ms. Brill is a fierce advocate for patients and a real watchdog over PBMs. She understands the vital role community pharmacies play in health care and our concerns.

Ms. Brill was the chief of consumer protection and antitrust at the North Carolina Department of Justice. Before that, she was the head of antitrust section in Vermont, where she worked tirelessly to get PBM regulation legislation passed. In North Carolina, Ms. Brill was one of the lead attorneys in state cases against PBMs. She has a strong sense of how they harm both consumers and pharmacists. She has been a strong advocate for states getting involved in monitoring CVS Caremark conduct. She is sensitive to the concerns of community pharmacists, especially in rural areas.

Senate hearings, testimony, and confirmation votes all need to occur before Ms. Brill joins the FTC. But her nomination is a very welcome development.

Executive Update will not be published next Friday. Please enjoy a safe and happy Thanksgiving.


]]> General http://www.ncpanet.org/blog/index.php?itemid=279 Fri, 20 Nov 2009 06:00:00 -0400