Medicare Rx discount card ups long-term care fees

October 25, 2004

In an attempt to help more nursing home patients take advantage of the Medicare drug discount card program, Community Care Rx has sweetened the reimbursement deal for participating long-term care pharmacists.

In an attempt to help more nursing home patients take advantage of the Medicare drug discount card program, Community Care Rx has sweetened the reimbursement deal for participating long-term care pharmacists.

The Centers for Medicare & Medicaid Services singled out Community Care Rx (CCRx) and two other discount card sponsors to oversee administration of a $600 credit for eligible low-income Medicare beneficiaries living in nursing homes. CMS estimated that the credit would benefit 200,000 such patients. But so far, fewer than 2,000 eligible beneficiaries have been enrolled.

On the pharmacy front, only 3,000 LTC pharmacies have endorsed or signed on with CCRx. One of the problems was its reimbursement rate was too stingy. Early last month, the nonprofit firm owned by the National Community Pharmacists Association began paying participating LTC pharmacies higher reimbursements for skilled-nursing and nursing home patients, according to Scott Hughes, VP-director, MemberHealth Inc., the Ohio pharmacy benefit manager overseeing the CCRx program.

"This is our response to your input that the program as initially configured didn't pay enough and didn't represent the value that long-term care pharmacy provides," Hughes told LTC pharmacists participating in a recent conference call. "We think that based on input from NCPA, we've made changes that make this a better business proposition. Now it's up to you to go out and provide this service to the people you serve."