Independent pharmacies seek carve out

Monday, May 30, 2011

WASHINGTON - Independent pharmacies are making another play at keeping themselves out of the competitive bidding program.

On May 23, Reps. Aaron Shock, R-Ill. and Peter Welch, D-Vt., introduced the Medicare Access to Diabetes Supplies Act, which seeks to exempt independent pharmacies with 10 or fewer locations from having to competitively bid for diabetes testing supplies.

"We think it has multiple wins for everybody," said John Coster, senior vice president of government affairs for the National Community Pharmacists Association (NCPA). "It will save money for Part B, it will save beneficiaries on the co-pay, and it will maintain access to supplies."

Currently, the competitive bidding program applies only to diabetes supplies obtained through mail order, but CMS has indicated that it may expand the program to include supplies obtained at retail locations.

The bill also seeks to exempt independent pharmacies from other parts of the bidding program: In 2016, for example, CMS plans to apply bid prices to all diabetes supplies.

Additionally, the bill would allow independent pharmacies to continue delivering diabetes supplies. In 2010, Medicare expanded the definition of "mail order" to include any supplies shipped or delivered, by any means, to the beneficiary's home.

"It doesn't make a lot of sense that the pharmacy can deliver prescriptions but not diabetes supplies," said Coster. "The reaction we've gotten from staff on the Hill is, 'You can't be serious.'"

CMS has indicated that it plans to create a national mail order bid for diabetes supplies, something the NCPA has long argued against. Independent pharmacists play a big part in keeping patients healthy, it argues.

"Many patients can manage themselves and do a good job, but many need a little more help and follow-up," said Coster. "They are not going to get that through the mail."

A similar bill introduced last year collected 24 co-sponsors.