|
|
|
From the Director
It may be the New Year, but the issues remain the same ...
** As state legislatures around the country convene, most have major budget deficits, and several are rolling back prescription drug benefits for seniors and in Medicaid... as well as dealing with PBMs, academic detailing, food for docs & more...
** We finally hear from the FTC on at least one PBM, with a narrow settlement responding to consumer complaints about CVS Caremark ... while NLARx and other consumer groups continue to oppose the merger of PBMs Express Scripts & Medco...
** Ratification of the KORUS free trade agreement, and how it may affect drug prices, brings the Korean Broadcasting System to Maine...
IN OTHER NEWS:
CONFLICTS OF INTEREST: Why do advocates for drugs get to vote and critics are barred from FDA panels?
Read more
REBATES HELP STATES PAY FOR AIDS DRUGS
Read more
SOCIAL MEDIA: FDA ISSUES GUIDANCE... SORT OF Read more
 
Check out the News Ticker for a variety of interesting articles from the past weeks. For more regular updates, the best way to stay current is to "like" us on Facebook and follow us on Twitter (where we tweet with the handle @nlarx nearly daily). Keep in touch!
Sincerely, Sharon Treat
|
 State Roundtable: Rx Program Cuts, PBM Regulation in the Offing, Food for Docs More
NEW YORK: State leaders cut the $322 million Elderly Pharmaceutical Insurance Coverage program by 45 percent , affecting 292,000 New York seniors under last year's budget. Cuts to prescription benefits under the EPIC program took effect last week. The program is designed to help lower-income people over 65 pay out-of-pocket expenses associated with Medicare Part D drug coverage, including co-pays, deductibles and premiums. With the changes, enrollees won't get assistance with co-pays until they reach the Medicare "doughnut hole," the gap between the initial coverage limit and the "catastrophic" coverage threshold. More
MAINE: Governor LePage proposes cutting Medicare Savings Plan (MSP) for 72,000 Maine seniors and disabled. The MSP provides wraparound payments that cover Part B Medicare premiums and Medicare Part D costs for seniors in the "donut hole" - paid by the federal government. More
Learn more about state pharmaceutical assistance programs such as the MSP on the National Conference for State Legislatures website
UTAH: A Utah legislator, Rep. Dixon M. Pitcher, has introduced legislation, HB54, "Prescription Drug Access in Rural Areas," that would prohibit PBMs from charging higher copayments for prescription drugs if patients who live in rural areas of the state choose to buy their medications locally rather than using an out-of-state mail-order pharmacy. "They control how much pharmacies get reimbursed for the prescriptions they dispense. And often a person who goes through one of their local pharmacies instead of using a mail-order plan required by their insurer will have a higher copay," s Rep. Pitcher, said in news reports. "So it can be losing proposition for both the patient and local pharmacists." More
FLORIDA: A Florida legislator, Senator Fasano, has also introduced a PBM bill, SB 310, regulating pharmacy audits and increasing transparency.
DISTRICT OF COLUMBIA: THE Committee on Health held a public oversight hearing on the Academic Detailing Program last month. The Academic Detailing program provides evidence-based, unbiased education to physicians in the District of Columbia on various treatments and pharmaceuticals available to treat certain diseases and conditions. As part of its ongoing efforts, the Academic Detailing program is preparing to unveil an HIV education module.
MASSACHUSETTS: Lots of talk, no action on repeal of gift ban and limits on food for doctors.
ALASKA: Rep. David Guttenberg outlines a full agenda of Prescription Drug Legislation for 2012.
The legislation consists of six bills each aiming to reduce costs in a different way.
· HB 42 addresses discount regulations by placing requirements on pharmacies and the Department of Health and Social Services.
· HB 43 requires the use of generic drugs when appropriate to lower costs.
· HB 44 establishes a prescription drug card program for discounts and allows the State to negotiate drug prices.
· HB 45 allows for savings through reporting of marketing costs.
· HB 46 establishes an Alaska Prescription Drug Task Force whose mission is to make recommendations on how to lower costs.
· HB 47 allows for public access to a database of clinical trials performed in Alaska.
|
Pharmacies, PBMs and "Mispricing" of Medications The FTC finally took action last week on complaints that CVS Caremark engaged in a wide range of anti-consumer practices. While disappointing NLARx and other consumer organizations because the settlement was limited to only one of the charges, and the penalty seemed, on its face, rather low, the settlement confirmed "mispricing" of drugs on CVS's Medicare Part D list, off by as much as 10 times the true cost. As we pointed out, the actual harm done to seniors choosing the CVS plan over rival plans that were accurately priced goes beyond the increased dollar amount paid for the drugs. Some enrollees no doubt went without medications as the inflated price pushed them into the donut hole quicker, while others choosing the plan in order to benefit from cheaper list prices might have been better off with a different plan entirely, once true costs and scope of coverage were factored in.
So called "mispricing" is not a minor matter and where CVS has been fined in recent years for pricing violations in Masschusetts and California, we're skeptical about these "inadvertent" actions that benefit the bottom line. The Washington Post article on the FTC proposed settlement makes this clear, citing the [CVS plan] RxAmerica posting the price of a generic epilepsy drug called gabapentin as $26.83, when the actual price was $257.70, and the price listed on the RxAmerica website for megestrol, a generic drug used to treat breast cancer symptoms, posted at $55.68, actually costing more than five times that amount.
The National Community Pharmacists Association shares our perspective on the settlement, expressing regret that "... the FTC's actions fell short of more robust protections for consumers and pharmacy competition" and calling on Congress and state legislatures to enact legislation, such as S. 1058/H.R. 1971, "that provides transparency and promotes pharmacy competition and consumer protections to address these types of questionable practices." NCPA has a good point; antitrust law is probably a blunt instrument for delving into these practices, and one of the biggest issues has been simply the lack of applicable law to both prevent and address PBM problem behavior.
Of course CVS isn't the only company with pricing issues. Just yesterday, the UFCW union benefits fund filed a lawsuit against Walgreen and Par Pharmaceutical for colluding to overcharge for generics. As the Wall St Journal points out, Walgreen in 2008 agreed to pay $35 million to the U.S., 42 states and Puerto Rico for overcharging state Medicaid programs by filling prescriptions with more expensive dosage forms of ranitidine, a generic form of Zantac and fluoxetine, which is a generic form of Prozac.
Want to learn more about PBMs and model legislation to increase transparency & accountability? Check out the NLARx website's PBM page. |
|
|
|
|
|
Join NLARx on Facebook and Twitter!
For up-to-the-minute posting of news of interest and events, become a fan of NLARx on Facebook here and follow us on twitter here. |
|
|
