State Leaders Criticize New Medicaid Prescription Rules
State Medicaid directors and more than 100 organizations on Monday plan to send a letter to congressional leaders to seek a one-year delay of a rule that will require pharmacists to reject paper prescriptions for Medicaid beneficiaries not written on tamper-resistant paper, according to Martha Roherty, director of the National Association of State Medicaid Directors, USA Today reports.
The rule, part of a supplemental appropriations bill for military operations in Iraq and Afghanistan enacted earlier this year, will take effect on Oct. 1.
According to critics, the rule could affect access to medications for Medicaid beneficiaries and force pharmacies to return reimbursements when they fill prescriptions improperly.
Jamila Edwards of the California Primary Care Association said, "Nobody really knew where this came from," adding, "The patient's going to be in the middle thinking, 'How come I didn't get my medication?'" Washington state Medicaid Director Doug Porter said, "In our state, very few doctors use these kinds of pads," adding, "I think some people will be denied service, and that will be a very bad situation."
However, Jeffrey Kelman of CMS said that the rule will allow pharmacists to fill prescriptions not submitted on tamper-resistant paper, provided that they obtain confirmation from the physicians who wrote the prescriptions by telephone, fax or e-mail within three days. He added that the rule should help to prevent overdoses and other problems caused by fraudulent prescriptions (Wolf, USA Today, 9/17).
In related news, Rep. Frank Pallone (D-N.J.) might introduce legislation to revise a rule recently finalized by CMS that will reduce Medicaid reimbursements to pharmacies for generic medications, according to a congressional source, CongressDaily reports (Edney, CongressDaily, 9/14).
The rule, mandated by the Deficit Reduction Act of 2005 and scheduled to take effect on Dec. 30, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities. The rule will redefine the average manufacturer price for brand-name and generic medications. States use AMPs to calculate Medicaid reimbursement rates for medications. Under the rule, the federal government will post AMPs on a Web site that consumers could access. In addition, the rule will limit the federal share of the cost of brand-name medications when at least three generic versions are available. The rule will exclude pharmacy benefit managers, and pharmacies in nursing homes and assisted living facilities. According to CMS, the rule will save the federal government and states $8.4 billion over the next five years (California Healthline, 7/10).
According to the source, Pallone might introduce legislation similar to a bill (S 1951) sponsored by Sen. Max Baucus (D-Mont.) that would exclude mail-order pharmacies from the rule and exclude rebates and discounts not provided to pharmacies from the calculation of AMP. The bill sponsored by Baucus also would increase Medicaid reimbursements for medications to 300% of AMP from 250%. Pharmacies, which maintain that the rule will prevent their participation in Medicaid, said that they support the bill.
Charles Sewell, vice president of government affairs for the National Community Pharmacists Association, said, "Right now, our biggest concern is getting something passed because there's a ticking time bomb when this goes into effect in January."
Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores, said that the bill represents a "much better policy than exists today" (CongressDaily, 9/14).