Unhappy New Year: Without congressional action, seniors could lose access to medical supplies

December 17, 2009

By National Community Pharmacists Association executive vice president and CEO Bruce T. Roberts, RPh 
The Hill

On December 31st people reflect on the concluding year and look forward to the next year. For many seniors this day will also mark the end to a key aspect of their health care. Up until that point seniors can get their prescription drugs and medical supplies at their community pharmacy. It’s convenient and provides patients with access to pharmacists who are trained to maximize health outcomes. Come January 1st the second half of that consumer benefit could end. 

For seniors trying to obtain essential medical supplies like diabetes testing strips, canes and walkers the following scenario could occur across the country: the pharmacist will glumly explain, "I apologize, but due to a ridiculous federal regulation I am no longer able to sell those supplies to you." For seniors, especially in underserved rural and urban areas, this unwanted development could possibly compromise their health. 

The regulation is a Medicare Part B Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation requirement for pharmacies. The policy is one of many that is designed to prevent fraud, but there is scant evidence pharmacists perpetrate these crimes. In addition, pharmacists are already subject to regulation and fines at the state level. Despite exempting 17 other medical providers, the federal government is requiring pharmacists to undergo a time-consuming, expensive, and redundant process to continue selling the same DMEPOS items they have sold for years. 

A cost benefit analysis is why many community pharmacies, in particular, might stop offering DMEPOS. According to the 2009 NCPA Digest, sponsored by Cardinal Health―an annual survey of community pharmacies―73 percent sell DMEPOS, but on average over 90 percent of their revenue comes from prescription drug sales. In other words, pharmacy owners might determine they cannot justify the cost and time commitment of the lengthy accreditation process for what may be just a fraction of their revenue. 

Congress is intervening to right this injustice. Provisions exempting pharmacies from the requirement are included in both health care reforms bills―the version passed by the House and the version being considered in the Senate. Indeed, the regulation would already be in effect had Congress not provided a lifeline to pharmacists and their patients this past October. That was the original month for the accreditation compliance to begin, but an extension was provided to the end of the year. Congress wanted, and is still working on, a more substantive partial exemption of the accreditation requirement for pharmacies as part of health care reform. Another extension to the current December 31 deadline is now needed because the larger reform bills will almost certainly not be completed by then. 

That is why we are calling on the House and Senate to do the prudent thing for their constituents― community pharmacists and, most importantly, their patients―and extend the accreditation deadline until March 31st. This should allow enough time to pass health care reform, or to find an alternative way to address this issue. 

On a positive note, Senator Sherrod Brown (D-OH) recently introduced an amendment to the Senate health care reform bill, the Patient Protection and Affordable Care Act, addressing another unreasonable attempt to target pharmacies for the non-existent DMEPOS fraud. Pharmacies would be required to purchase $50,000 surety bonds to sell DMEPOS, even though 14 other medical providers have been exempted from a similar requirement. This deadline mirrored the accreditation one, but market forces provided relief. Fortunately to date, insurance companies have realized the pharmacies are a very low risk and have accordingly substantially reduced the price to purchase the surety bonds. As a matter of principle and of economic concern, however, we are glad that Sen. Brown’s amendment exempts pharmacists like all of the other medical providers. We are hopeful it will be adopted and included in any final bill that emerges from reconciliation with the House.

NCPA Media Contacts

Kevin Schweers
Senior Vice President, Public Affairs

John Norton
Director, Public Relations

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