Rx pushes for bidding exemption

Thursday, July 8, 2010

ALEXANDRIA, Va. - Pharmacy stakeholders are "cautiously optimistic" that pharmacies could get a pass on having to competitively bid diabetes supplies.

As part of the "2011 Proposed Medicare Physician Payment Rule," CMS said that exempting local pharmacies from competitively bidding the supplies would preserve beneficiary choice.

"That's really good news for us," said Ronna Hauser, vice president of regulatory affairs and policy for the National Community Pharmacists Association (NCPA). "We view it as a nice clue as to what CMS is thinking."

The proposed regulation would also exempt national chains like CVS and Walgreens.

Community pharmacies offer a continuity of care that mail order can't match--something that is especially important in managing chronic conditions like diabetes, says the NCPA.

"We look at ourselves as a one-stop shop," said Chris Smith, NCPA's director of policy and regulatory affairs. "The patient is already coming to the pharmacy to get their diabetes medications. This way they can use a consultant to make sure they are using everything properly."

While CMS says that 62% of beneficiaries already get their supplies through mail order, the NCPA says that requiring community pharmacists to compete against mail order suppliers would result in a loss of local access for beneficiaries.

In May, Reps. Peter Welch, D-Vt., and Mike Rogers, R-Mich., introduced H.R. 5235, the Medicare Access to Diabetes Supplies Act. The bill would exempt diabetes supplies that are furnished by pharmacies with annual sales of $7 million or less. It currently has 13 co-sponsors.

"We will continue to promote that and seek sponsors," said Hauser. "There may be a point in time when we could absolutely still need those protections."

CMS also released instructions for exempting most small pharmacies from accreditation requirements, a provision included in the Patient Protection and Affordable Care Act that passed in March.

Pharmacies that want to be considered exempt must meet all of the following criteria:

* The total billings by the pharmacy for DMEPOS are less than 5% of total pharmacy sales for the previous three calendar years;

* The pharmacy has been enrolled as a supplier of DMEPOS and has been issued a provider number for at least five years;

* No final adverse action has been imposed on the pharmacy in the past five years

* The pharmacy submits an attestation, in the manner and at the timeframe to be determined, that the pharmacy meet the criteria listed in 1-3;

* The pharmacy agrees to submit materials as requested during the course of an audit conducted on a random sample of pharmacies selected annually.

Pharmacies that don't meet the criteria for an exemption have until January 1, 2011 to become accredited. To read the fact sheet, go here: http://www.cms.gov/MedicareProviderSupEnroll/Downloads/DMEPOSAccExemptFo...