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NCPA gives take on cutting Medicare Part D waste, abuse
October 5th, 2011
ALEXANDRIA, Va. – For a Senate hearing, the National Community Pharmacists Association provided some recommendations on ways to cut waste, fraud and abuse in the Medicare Part D prescription drug benefits program.
NCPA said it submitted comments for a Tuesday hearing, titled "Costs of Prescription Drug Abuse in the Medicare Part D Program," held by the U.S. Senate Homeland Security and Government Affairs Subcommittee.
The association's suggestions to the federal government included the following:
• Ensure that requirements to use National Provider Identifier (NPI) numbers on Part D claims provide for an adequate transition to avoid inadvertently penalizing pharmacies acting in good faith to serve patients. "S. 1251, the Medicare and Medicaid FAST Act, would require that every health care provider obtain and be required to use an individual — not a group — NPI number for prescription claims," NCPA stated. "However, today prescribers continue to use group NPIs and the policies of Part D plans regarding NPI use vary from plan to plan."
• Make certain that the government receives "billions of dollars in manufacturer rebate savings currently retained by pharmacy benefit managers (PBMs) under the Part D program," NCPA said in its comments. The association noted that the U.S. Department of Health and Human Services' Inspector General issued two reports in the past year that collectively found that most PBMs/plan sponsors don't pass on to beneficiaries the full amount of rebates and discounts.
• Promote the "appropriate use" of generic prescription drugs. According to NCPA, community pharmacies dispense generic drugs over 10% more often than mail-order pharmacies, which the group said benefit from brand-name manufacturer rebates. NCPA also cited "automatic shipping" by PBM-owned mail-order pharmacies that "can leave patients with excess medications, which they consistently dispose of at local community pharmacies."
• Require Part D plans to implement consistent pharmacy audit practices to strengthen fraud protections and focus on true fraud. NCPA stated that pharmacies make up just 0.2% of the "excluded providers" banned from Medicare and other federal programs. "Yet law-abiding pharmacies are being targeted for auditing and fines that have little or nothing to do with fraud but rather appear to be an effort to increase the profits of PBMs/plan sponsors," the association said in its comments.
"NCPA and its members remain committed to combating waste, fraud and abuse within federal health care programs and stand at the ready to assist with these efforts," NCPA told the subcommittee. "It is important for Congress to also focus on the existing waste within and potential savings from how pharmacy benefit managers operate in the Medicare Part D program. In the end, NCPA seeks to partner with the federal government in the right way to generate health care savings, while providing high quality health care to our patients."