In letter to CMS, Congress requests better data before short-cycle dispensing implementation

March 18, 2011

The U.S. House of Representatives requested in a letter to CMS that the agency consider the delay of a provision in a recently proposed rule requiring certain prescriptions to be dispensed in 7 days or less increments.

The U.S. House of Representatives requested in a letter to the Centers for Medicare and Medicaid Services (CMS) that the agency consider the delay of a provision in a recently proposed rule requiring certain prescriptions to be dispensed in 7 days or less increments. The letter echoes the concern of healthcare organizations that the agency lacks data on the rule's impact on program costs, pharmaceutical waste, and patient safety.

The American Society of Consultant Pharmacists (ASCP) previously commented that the proposed rule's timetable for implementation would put patient safety at risk and increase the likelihood of medication errors from an increased number of dispensing events per patient.

Twenty healthcare organizations - including the ASCP, the Academy of Managed Care Pharmacy, American Pharmacists Association, and the National Community Pharmacists Association - requested that the agency provide more time for implementation of the rule. The organizations also encouraged the agency to perform a pilot or study of 7 days or less dispensing in order to better understand its impact on patient safety and healthcare costs, as well as its interaction with rules governing controlled substances and the disposal of hazardous waste.

The proposed rule would require pharmacies to dispense most brand-name medications to Medicare Part D beneficiaries in nursing homes in 7 days or less supplies, beginning in 2012. It also requires nursing homes to return unused medication to pharmacies for documentation purposes. The rule is intended to reduce waste generated by 30-day dispensing in long-term care (LTC).

An independent study, sponsored by the Long Term Care Pharmacy Alliance and conducted by Managed Solutions, LLC, was recently undertaken to estimate the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.

The results of the study, which evaluated 8 LTC facilities, indicated that applying a 7-day fill time to roughly 59 million brand and generic oral solid prescriptions each year will result in an additional 194 million dispensings annually. Applying an average dispensing fee of $4.74 to each additional dispense results in a net additional cost of more than $820 million to Part D plans.

The total annual cost of unused oral solid medications was estimated at $125 million.