In brief: Lower premiums, NMEDA training, Rehab Medical’s expansion

 - 
Friday, October 23, 2020

WASHINGTON – Premiums for HealthCare.gov plans are lower for the third consecutive year, according to a new report from CMS. 

The average premium for the second lowest silver plan, or benchmark plan, on the federal health care insurance exchanges dropped by 2% for the 2021 coverage year, the report shows. 

“Our changes to the regulations and how we have managed the exchanges have proven to be more effective than previous administrations,” said CMS Administrator Seema Verma. 

Overall, there has been an 8% reduction in premiums across the exchanges since the 2018 coverage year, according to CMS. 

The report also shows that 22 more issuers will offer coverage on the exchanges in 2021 for a total of 181 issuers delivering more choice and competition for consumers. 

CMS says that while the report shows the administration’s efforts to stabilize the market are working, average premiums are still higher than when the Affordable Care Act was first implemented and affordability remains a challenge for people who do not qualify for a premium tax credit and must pay the entire premium themselves. 

Consumers will be able to start enrolling in plans for the 2021 plan year beginning on Nov. 1. 

NMEDA brings in UPitt to boost education, training 

TAMPA, Fla., and PITTSBURGH – The Department of Rehabilitation Science and Technology in the University of Pittsburgh’s School of Health and Rehabilitation Sciences will oversee the education and training programs offered by the National Mobility Equipment Dealers Association. 

The agreement calls for UPitt’s Amy Lane, an occupational therapist and certified driver rehabilitation specialist, who manages and operates SHRS’s Adaptive Driving Program, to serve as NMEDA’s director of education and training, and to spend at least 50% of her time devoted to the association. 

“The RST Department at Pitt is recognized globally for their expertise and innovation in all kinds of mobility applications,” said Christian Quandt of Advanced Wheels in East Granby, Conn., and NMEDA president. 

UPitt will also make available RST’s Continuing Education team to NMEDA to assist with their Learning Management System implementation and ongoing online education offerings. 

UPitt and NMEDA have worked together before, most recently on a “Rolling Disrupters” panel at NMEDA’s annual conference earlier this year that featured Dr. Rory Cooper, professor, RST, and founder and director of the Human Engineering Resources Laboratories at UPitt. 

Rehab Medical expands presence in Ohio 

INDIANAPOLIS – Rehab Medical will open two new offices in Toledo and Dayton, Ohio, to better serve patients.  

“I am very excited to expand our reach into additional markets,” said Jarrad Rankin, vice president of operations. “We have put a lot of effort into building an effective and efficient service model, centered around sense of urgency and patient care.”  

Rehab Medical has had a presence in Dayton for several years, and with the recent promotion of Calvin Hodder to sales manager, the new offices were needed to expand resources and provide more accessibility to mobility equipment to better serve a larger patient population. 

The company is experiencing a growth spurt this year. Earlier this month, the provider opened a fourth location in Indiana and expanded into Texas with its acquisition of San Antonio-based Wheelchairs Plus. 

Tricare to stop recoupments on compounded meds 

ALEXANDRIA, Va. – TriCare/Express Scripts will no longer seek to recoup prescriptions from compounding pharmacies from 2015 that it says were fraudulent because there was no physician/patient relationship indicated. The amounts to be recouped ranged from less than $100 to more than $200,000. “ESI was basically saying that the only way the pharmacies could exonerate themselves was by producing documentation that the prescribing physician actually had seen the patient,” said Scott Brunner, CEO of the Alliance for Pharmacy Compounding. “That’s documentation that no state in the nation requires pharmacists to maintain.” Both APC and the National Community Pharmacists Association also say that ESI’s communication to pharmacies about the recoupment was incorrectly dated and full of errors about the claims they were seeking to recoup. They took their concerns to the Defense Health Agency, which oversees Tricare. In response, Tricare has instructed ESI to stop the recoupments it started in June. Pharmacies that have already suffered clawbacks will be allowed to appeal and the standard for documentation of those appeals will now be reasonable. 

 VGM seeks Heartland speakers 

WATERLOO, Iowa – VGM is now accepting speaker proposals for its 2021 Heartland Conference, which takes place June 14-16 in Waterloo, Iowa. Organizers are looking for presenters to offer their expertise on a variety of topics, including business leadership and management, retail, sleep and respiratory, rehab, operations, sales and marketing, home accessibility, technology and regulatory. “There’s no shortage of opportunity for presenters at the Heartland Conference,” said Kayla Mahler, Heartland education chair. “It’s the perfect place to bring visibility and quality leads to their business. But, more than that, it’s the community—it’s the sharing of ideas and inspiration that lets you make a real impact on the industry as a whole.” Proposals are due Dec. 18. Those interested should visit www.vgmheartland.com/speak to complete the online form, or contact Kayla Mahler at kayla.mahler@vgm.com or Jill Blaser at jill.blaser@vgm.com, or call 855-755-6922. 

ACHC merges with HFAP 

CARY, N.C. - The Accreditation Commission for Health Care and the Healthcare Facilities Accreditation Program are merging to form a single company. HFAP will operate as a branch within ACHC and, collectively, the organization will be known as ACHC. “Together, the combined services of ACHC and HFAP open possibilities for health care providers, affording them more choices and greater ease in meeting the accreditation and certification needs of their organizations,” said Jose Domingos, president and CEO of ACHC. It’s the first time two accrediting organizations with deeming authority from CMS have merged. The two organizations believe the merger streamlines accreditation and certification services for health care providers with multiple survey needs. ACHC has CMS deeming authority for home health, hospice, renal dialysis, home infusion therapy and DMEPOS; HFAP has it for hospitals, ambulatory surgery centers, clinical laboratories and critical access hospitals. The merger will not affect the accreditation cycles for either ACHC or HFAP customers. ACHC staff will remain in Cary, N.C. HFAP staff are based in either Chicago or Cary. 

ZOLL partners with CAIRE for vent-POC package 

CHELMSFORD, Mass. - ZOLL Medical has exclusive rights to distribute CAIRE’s SAROS 4000 portable oxygen concentrator in all markets outside of the U.S. in combination with its EMV+ ventilator. By combining SAROS with the EMV+, remote medics will be able to deliver oxygen-enriched critical care ventilation and oxygenation therapy without the use of oxygen cylinders, which present refilling and logistical challenges, and are a hazardous threat in armed conflicts, the companies say. “The logistical burden of exchanging empty oxygen cylinders in the field presents considerable challenges for militaries, including the risk of explosion and the need for aircraft and personnel to transport cylinders to and from the field,” said Elijah White, president of ZOLL Resuscitation. “This is a game-changing advancement.”  

Awards season: NCPA names award winners at virtual convention 

The National Community Pharmacists Association has named Amina Abubakar, owner of Rx Clinic Pharmacy in Charlotte, N.C., the 2020 Willard B. Simmons Independent Pharmacist of the Year. The award, sponsored by Upsher-Smith Laboratories, is given to a pharmacist who exhibits exemplary professional leadership, service to community and commitment to independent pharmacy. Abubakar, who grew up in Kenya, opened Rx Clinic Pharmacy in 2009, specializing in treating HIV patients. She is a passionate advocate for patients with HIV/AIDS, presenting to the community on the subject and participating in patient support groups to offer education and empowerment services. Abubakar and Rx Clinic Pharmacy are also involved in local health fairs and seminars, promoting various health screenings for early detection of diseases and linkage to care. They offer immunizations and point-of-care testing in the community, as well…The NCPA has named Nasir Mahmood, owner of Pine Plains Pharmacy and resident of Wappingers Falls, N.Y., as the recipient of the 2020 Calvin J. Anthony Lifetime Achievement Award. The award honors a pharmacist who has dedicated his or her career to the advancement of the pharmacy profession. Throughout his career, Mahmood has been active in professional organizations, including the NCPA, the Pharmacists Society of the State of New York, the American Pharmacists Association and the Hudson Valley Pharmacists Association. While president of the PSSNY in 2008-09, he was instrumental in state legislation that allows pharmacists to become immunizers for influenza and pneumococcal disease…The NCPA has named William Scharringhausen, a third-generation pharmacist/pharmacy owner from Park Ridge, Ill., as the recipient of the 2020 John W. Dargavel Medal. The award, sponsored by McKesson, honors an individual whose contributions on behalf of independent pharmacy embody the spirit of leadership and accomplishment personified by John W. Dargavel. Scharringhausen has been very involved in local Park Ridge organizations, including the area Jaycees, Chamber of Commerce, Kiwanis Club, Men’s Prayer Breakfast and the Park Ridge Community Church. He has also been active in the NARD/NCPA throughout his career…The NCPA has named Beverly Schaefer, co-owner of Katterman’s Sand Point Pharmacy in Seattle, the recipient of the Sharlea Leatherwood Memorial Trailblazer Award. The award recognizes an outstanding pharmacy owner whose pharmacy blazes a trail for other independent pharmacy owners and future generations of independent pharmacy owners. Schaefer is a 40-year member of the NCPA. She has served on many of the association’s steering committees, provided numerous hours of continuing education to attendees of its annual convention and mentored pharmacy students participating in an annual business plan competition...The NCPA has named Mayank Parikh the recipient of the NARD Ownership Award. The award recognizes an independent community pharmacist who embraces entrepreneurial spirit through promotion and demonstrated excellence in the field of community pharmacy ownership. Parikh is a second-generation health care provider who has helped to grow Super Health Pharmacy in Staten Island, N.Y., to 10 independent pharmacies in various areas of the Tri-State area. He has converted the pharmacies into full-service COVID-19 testing centers and transformed them into a place where customers can have their prescriptions or daily essentials delivered for free the same day. 

NSM expands workers’ compensation team 

NASHVILLE, Tenn. – National Seating & Mobility has added Cynthia Petito and Robert Davies to its National Workers’ Compensation Program service team. Petito will serve as program manager, workers’ compensation & centralized access; and Davies as general manager of home access solutions/general contractor. “Our NSM360 National Workers’ Compensation Program exists to ensure a fully integrated solution to help NSM clients who are injured at work gain self-reliance and independence in their homes and communities,” said Brendan Swift, vice president of the program. “With the addition of these two industry veterans, our team is better positioned to enhance the services we provide the workers’ compensation industry.” Petito, an ATP with certifications as an aging-in-place specialist and certified environmental accessibility consultant, will lead NSM’s centralized service team based in Largo, Fla., providing complete mobility and home and vehicle accessibility services to injured workers and clients throughout Florida and 47 states. Davies, who has extensive experience in project management, payer relations and home accessibility options, will oversee projects and assist NSM’s branches, working directly with payers to ensure injured workers receive the best solution for their needs. 

Itamar names president for US market 

CAESAREA, Israel – Itamar Medical has appointed Shane Brown as president-U.S. effective immediately. In this role, he will oversee commercial strategy and execution in the U.S. as the company plans to further accelerate its investment in penetrating that market. Brown brings more than 20 years of commercial experience to the position, including leading the early adoption of emerging therapies in the medical device, digital health and medtech markets. Most recently, he served as vice president, enterprise accounts at Abbott Laboratories. “Itamar’s recent growth has largely been driven by strength in our U.S. core sleep business, as sleep centers continue to adopt our WatchPAT ONE product,” said Gilad Glick, president and CEO of Itamar Medical. “We’re confident that Shane’s rich experience and success in growing commercial organizations in the cardiology medical technology sector will provide us with further leverage and focus, as we seek to expand our reach to the estimated 54 million to 60 million adults living in the U.S. suffering from sleep apnea.” 

NCPA report highlights market opportunities, challenges 

ALEXANDER, Va. – Independent community pharmacies comprised 35% of all retail pharmacies in the United States and represented a $73.6 billion marketplace in 2019, according to the 2020 NCPA Digest. Other highlights from the report, sponsored by Cardinal Health: The estimated number of independent community pharmacies continues to decline, falling to 21,683 stores; and the number of prescriptions filled by those pharmacies dropped to 57,414 per store. The report also highlights the wide variety of services offered by independent community pharmacies: In 2019, 79% offered medication synchronization services; 79% offered medication therapy management; 77% provided flu immunizations; 73% offered non-flu immunizations; 54% performed blood pressure monitoring; and 53% furnished durable medical goods. “The report details the many indispensable services patients are able to access at their neighborhood pharmacies and also some of the pressures they face that can make it difficult to keep their doors open,” said NCPA CEO B. Douglas Hoey. “The opportunities and challenges alike have been magnified by the coronavirus pandemic, but as we look to the development of vaccines and overcoming the virus, the importance of community pharmacy has never been clearer.” Additionally, the report highlights a number of trends, including their reliance on government programs (55% of total prescriptions are covered by the Medicare Part D and Medicaid programs) and their presence in rural areas (77% of community pharmacies serve population areas of 50,000 or fewer). 

NCPA seeks scrutiny of PBM partnership 

ALEXANDRIA, Va. – The National Community Pharmacists Association says that a partnership between to pharmacy benefit managers will harm local pharmacies. 

In a letter to The National Association of Attorneys General, the NCPA asks for scrutiny of the partnership between Express Scripts and Prime Therapeutics. 

Express Scripts is owned by Cigna and controls prescriptions for 75 million people; Prime Therapeutics is owned by a consortium of Blue Cross Blue Shield companies and covers more than 30 million people. 

“These two companies operating separately already exert tremendous downward pressure on independent pharmacies. By joining forces, they can put many out of business and steer their patients to larger competitors,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “There’s nothing competitive or fair about that, and in the end, patients will lose access to their preferred local health care providers.” 

The NCPA recently launched “The Truth,” a campaign that seeks to shine a light on PBM practices.