Capital Capsules for April 2, 2001
Key provisions of pending medical record privacy regulations that NACDS and PCMA want the Bush Administration to scrap are not a problem for NCPA. One difference is over patient consent. Under the rules issued on Dec. 28, and since then delayed, R.Ph.s could not fill an Rx after Feb. 26, 2003, until a patient signed a one-time consent form. Patients also would have to specify who could pick up their Rxs. "Chaos at the counters" is the prediction of Carlos Ortiz, R.Ph., CVS director of government affairs. Ortiz has been a prominent figure for the Healthcare Leadership Council, a coalition of CEOs connected to the industry. HCL wants any identifiable health-care data to be available for use and disclosure for treatment, payment, and health-care operations without consent. NCPA, however, reiterated its long-standing policy supporting informed consent. "We do not object to requiring patients to provide ... informed consent as to the persons to receive their prescriptions and to indicate whether and by what means they want ... subsequent information about their prescriptions," said John Rector, NCPA senior v.p. and general counsel.
Another concern is the "marketing" of identifiable information. HCL said the rule's marketing definition "attempts to define the undefinable." The section is "unnecessary" and should be dropped. "If patient-specific information is to be sold or used in marketing," said Rector, "we believe affirmative patient consent is appropriate...." The Bush Administration has delayed the start of the two-year phase-in of the rule until April 14; HLC wants it withdrawn and rewritten.
ASCP has outlined a new payment formula for Rx services consisting of four elements: product cost, overhead, compounding/dispensing fee, and professional medication management services. The draft plan was not rich in details, but was put out for discussion, said Tim Webster, ASCP executive director, at the 12th annual legislative conference last month. Under product cost, for example, ASCP said AWP has lost all credibility with Congress, HCFA, and state Medicaid directors. Possible alternatives listed were actual acquisition cost, WAC plus %, EAC, or other determined benchmarks. The dispensing and professional services fees would be based in part on their "intensity." Webster emphasized to Drug Topics that none of the other associations have endorsed the draft. "We are not abandoning AWP," he added. "We are recognizing that, in today's marketplace, AWP is under significant attack. We're looking for some alternative to those attacks that can provide an effective basis for payment to pharmacy."
The number of hospitalizations that might have been avoided had patients gotten timely, effective ambulatory care rose from 2.2 million in 1980 to 3.7 million in 1998or from 5.9% to 11.5% of all hospitalizations, according to CDC. Hospitalization rates increased for pneumonia, congestive heart failure, cellulitis, ruptured appendix, and potassium deficiency. They were down for asthma, bleeding ulcer, and inflammation of the kidney.
Mike Conlan. Capital Capsules. Drug Topics 2001;7:20.