AzPA Pharmacy Flash
Mar. 12, 2014

Update on federal provider status efforts
Today, March 11, HR 4190 was introduced in the U.S. House of Representatives to recognize pharmacists as providers under Medicare Part B.

The current legislation, introduced by Representatives Brett Guthrie, R-Ky., G.K. Butterfield, D-N.C., and Todd Young, R-Ind., will enable patient access to, and reimbursement for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Pharmacists, as the most accessible health care professionals, are uniquely positioned to provide patients in medically underserved communities access to health care services that are already within their scope of practice. By providing for a payment mechanism under Medicare Part B, the bill will allow pharmacists to help fill the gaps in care that have been created by shortages of health care professionals and increases in the number of Americans who are now eligible to gain health insurance under the Patient Protection and Affordable Care Act.

Although provider status has been a professionwide goal for many years, activity began picking up in early 2013 and have come to a head with the formation of the Patient Access to Pharmacists' Care Coalition. The coalition currently represents over 20 organizations and is continuing to grow. Members include organizations representing patients, pharmacists, pharmacies and other interested stakeholders.

This coalition is focused on developing and helping to enact a federal policy proposal that will enable patient access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Their primary goal is to expand medically underserved patients' access to pharmacist services consistent with state scope of practice law.

Getting HR 4190 passed may be a long-term effort — possibly even multiple years — that will require grassroots advocacy from all pharmacists. Get ready for action alerts asking you to send letters and emails and make phone calls to your legislators! Your state pharmacy association will continue to work with our national partners to make sure that you are kept up to date on the progress of HR 4190 and PAPCC. To read the press release from PAPCC, click here. More

CMS retreats from proposed rule — HR 4160 could repeal remaining provisions
In recent communications, the Arizona Pharmacy Association reported on proposed rules being considered by the Centers for Medicare and Medicaid Services. While the rule was not ideal, it contained a number of favorable provisions for pharmacy providers servicing Medicare Part D patients. These provisions include but were not limited to language allowing all pharmacy providers the opportunity to participate, expansion of patients eligible for MTM services, correction of mail-order cost-sharing issues and updating of MAC pricing standards.

CMS has undergone unprecedented pressure from Congress upon filing this rule draft and released a letter from Marilyn Tavenner to members of Congress, informing them that certain provisions of the Proposed Rule are being "held" at this time. More specifically, Tavenner notes that CMS will not be finalizing the more controversial elements of the Proposed Rule for CY 2015. These include the protected drug classes provision, the "any willing pharmacy"/preferred cost-sharing provisions, the changes to the number of plans sponsors may offer, and the non-interference provisions. CMS further notes that it "will engage in further stakeholder input before advancing some or all of the changes in these areas in future years."

Rep. Renee Ellmers, R-N.C., introduced HR 4160 on March 6, which was assigned to the House Ways & Means Committee and the House Committee on Energy and Commerce. HR 4160 would repeal the entire rule, including the remaining pro-pharmacy provisions in that CMS rule. Pharmacists are encouraged to reach out to your members of Congress and to express your opinions on HR 4160 which could be heard as early as March 11 in the House of Representatives. Should House bill HR 4160 pass, and if it is brought up for a vote in the Senate, ask Senator John McCain and Senator Jeff Flake to support the bill. Even though any willing pharmacy has been dropped by CMS, there are still pro-patient, pro-pharmacy provisions in the Proposed Rule that are currently alive but could be wiped out if Congress passes HR 4160. Also, remember that Members of Congress will be at recess and back in Arizona next week. This is a prime opportunity to schedule meetings with your members of Congress and ask them to support or introduce any willing provider pharmacy legislation. If they voted in favor of HR 4160, let them know how you feel about their vote. To find contact information for other members of Congress, click here.

Forgoing legislative action, CMS plans to move forward with some sections of the Proposed Rule, although it is currently unclear whether the MTM expansion will be among them. The letter states that the provisions that will be finalized — after considering public comment are "proposals related to consumer protections (e.g., ensuring access to care during natural disasters), anti-fraud provisions that have bipartisan support (e.g., strengthening standards for prescribers of prescription drugs), and transparency (e.g., broadening the release of privacy-protected Part D data)." AzPA will continue to keep members informed as we receive additional information on the Proposed Rule.

Nationally, there were 7,500 comments on the Proposed Rule, with many coming from pharmacists in support of its provisions. AzPA will definitely continue monitoring these important issues, keeping our members updated as we learn more. More

Improving daily health communication with patients
By Cynthia Sheppard Solomon
Pharmacists do a lot of "live" activities in their daily encounters with patients — evaluating lab results, health screens, potential drug interactions. Afterward, they often speak with the patient to reinforce how he or she currently views expectations and possible side effects of prescribed medicines. Each of these activities provides a heightened level of safety to our patients. So are pharmacists doing a good job these days?More

The war on drugs is lost; what comes next?
Most drug laws have to do with controlling availability. If you don't have a drug, you won't have a drug problem. That's great. It's very sensible. That is called supply-side control. The problem is that it never has worked in anything approaching a free society. Drugs are just too easy to grow, make, transport, give, buy, sell or steal.More

Concurrent prescriptions by multiple providers common and linked to increased hospital admissions
Medicare beneficiaries are receiving concurrent opioid prescriptions from multiple providers, placing them at increased risk for opioid-related hospitalization. The ability of patients to receive multiple prescriptions from providers who do not or cannot communicate with one another can lead to fragmented prescribing of opioids, which is particularly concerning with elderly people because of increased adverse events associated with opioid use. More

Study finds doctors prescribing more sedatives
HealthDay News
Doctors in the United States are writing more prescriptions for sedatives than ever before, and the frequent use of these powerful drugs in combination with narcotic painkillers may be causing medication-related deaths, a new study suggests.More

Pharmacists urge Medicare to implement pro-patient improvements to Part D drug plans
The National Community Pharmacists Association recently submitted comments to the Centers for Medicare & Medicaid Services urging the agency to finalize several pro-patient, pro-pharmacist provisions included in a recently proposed rule for 2015 Medicare Part D drug plans.More

Pro-vaccine messages may backfire among parents
Current public health messages about vaccines may be not only ineffective but also counterproductive among people who are suspicious about the potential effects of vaccines, according to a study published in Pediatrics.More

Antibiotics prescribed to majority of hospitalized patients
Pharmacy Times
A CDC report finds that reducing the rate of broad-spectrum antibiotic use in hospitalized patients could have a substantial impact on the rate of Clostridium difficile infection. More

Drug might help heavy drinkers limit their booze
HealthDay News
An anti-epilepsy drug might help problem drinkers reduce their alcohol consumption, according to new research. The study of the drug topiramate included 138 heavy drinkers who were divided into two groups.More

Amitriptyline 'arguably' effective for functional dyspepsia
Pharmacy Practice News
At long last there is good evidence that amitriptyline is effective for the treatment of functional dyspepsia. The data was generated by a multicenter study funded by the NIH.More

Pfizer recalls some antidepressants after drug mix-up
HealthDay News
Two lots of Pfizer's antidepressant drug Effexor XR are being recalled because they may contain capsules of another drug called Tikosyn, which is used to treat heart rhythm disorders.More

The implications of antibiotic overuse warrant attention to guidelines
Pharmacy Times
Up to half of antibiotics prescribed in the United States may be unnecessary, leading to avoidable adverse events and development of antibiotic resistance and attendant costs.More

2 new agents evaluated for 2 types of constipation
Pharmacy Practice News
Two agents designed to treat two different forms of constipation performed well enough in recent studies to encourage regulatory approval. Plecanatide was tested in a trial of patients with chronic idiopathic constipation, and naloxegol was tested for opioid-induced constipation. Both drugs exert most of their effects in the bowel wall, thus potentially avoiding systemic adverse events.More

Antibiotics prescribed to majority of hospitalized patients
Pharmacy Times
A Centers for Disease Control and Prevention report finds that reducing the rate of broad-spectrum antibiotic use in hospitalized patients could have a substantial impact on the rate of Clostridium difficile infection. More