LTC pharmacy group wants fair dispensing fees

January 23, 2015

The newly-formed Senior Care Pharmacy Coalition (SCPC), a group of independent long-term care pharmacies, plans to work with U.S. Congressional leaders to reintroduce the Medicare Efficient Drug Dispensing Act.

The newly-formed Senior Care Pharmacy Coalition (SCPC), a group of independent long-term care pharmacies, plans to work with U.S. Congressional leaders to reintroduce the Medicare Efficient Drug Dispensing Act.

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Introduced in the last session of Congress by Sens. Benjamin L. Cardin (D-MD) and Barbara A. Mikulski (D-MD), the Act prohibits Medicare Part D plan sponsors from using payment structures - including prorated daily dispensing fees - that “discourage the adoption of techniques designed to minimize the dispensing of unused drug,” Alan G. Rosenbloom, president and CEO of the SCPC, wrote in the January 20 issue of Roll Call.

The SCPC wants the legislation to receive wider exposure and bipartisan support. “Ultimately, federal laws and regulations that help to increase transparency, improve outcomes for the growing cohort of America’s most vulnerable seniors, and promote the more efficient use of taxpayer dollars, will gain bipartisan legislative support on the merits,” Rosenbloom wrote.

The SCPC was formed in early January to address three key issues that impact LTC pharmacies and their patients: Maximum Allowable Cost (MAC) pricing, daily dispensing fees, and Drug Enforcement Administration (DEA) relationships.

Independent LTC pharmacies and the patients they serve must be protected from the debilitating effects of secretive, opaque Medicare Part D drug reimbursement policies, the SCPC said in a statement. “These practices afford no recourse for pharmacies to ensure they are appropriately reimbursed for the drugs they dispense, resulting in inappropriate shifting of Medicare dollars from pharmacists providing the actual care to Part D intermediaries, such as pharmacy benefit managers (PBMs),” the statement said.

Likewise, the SCPC is also protesting a shift by the nation’s two largest PBMs from a monthly professional dispensing fee for pharmacies' professional services to a "daily dispensing fee," linked solely to the amount of medication dispensed.  “Once again, scarce Medicare dollars are shifted away from providers to Part D intermediaries – with no regard for the unique professional services that LTC pharmacists provide to nursing home patients,” SCPC said in the statement. “This practice impedes the migration to shorter dispensing cycles in certain LTC settings (required by the Affordable Care Act) and incentivizes medication waste that not just costs tax dollars, but presents environmental risks.”

Meanwhile, DEA policies governing controlled substances “adversely impact” independent LTC pharmacies' ability to deliver care to their patients residing in nursing homes, according to the group. “Congress must work with stakeholders to bridge the growing gap between the goals of DEA drug enforcement policies, Centers for Medicare and Medicaid Services (CMS) regulations, high standards of patient care, and market realities,” the statement said.