Pharmacy care shouldn't get lost in the mix as federal guidelines take shape for state-based health insurance exchanges mandated under health care reform, according to the National Community Pharmacists Association.


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NCPA speaks up for Rx on health insurance exchanges

November 1st, 2011

ALEXANDRIA, Va. – Pharmacy care shouldn't get lost in the mix as federal guidelines take shape for state-based health insurance exchanges mandated under health care reform, according to the National Community Pharmacists Association.

NCPA said Tuesday that this week it submitted comments to the U.S. Department of Health and Human Services (HHS) to stress that the rules for the health insurance exchanges, as set forth by the Affordable Care Act (ACA), should ensure adequate pharmacy access for patients and savings to taxpayers and patients from pharmacy benefit disclosure requirements.

"Federal and state officials from both parties are making considerable efforts now to make certain that patients will have access to affordable, quality medical coverage when health insurance exchanges open in 2014," NCPA chief executive officer B. Douglas Hoey said in a statement. "The services of community pharmacists, such as expert medication counseling, are critical to improving patient outcomes and reducing costs in these plans, as well as those outside of the exchanges."

In its letter to HHS Secretary Kathleen Sebelius, NCPA made the following recommendations:

• HHS should adopt the Department of Defense/TRICARE standard for pharmacy access in plans offered through the state exchanges. According to NCPA, that minimum standard sets an adjusted scale for pharmacy access in urban, suburban and rural communities (for example, at least 70% of beneficiaries in rural areas on average must live within 15 miles of a participating retail pharmacy). Plans should also consider, where appropriate, designating community pharmacies in low-income, underserved areas as "essential community providers."

• To maximize the savings from pharmacy benefit manager (PBM) disclosure requirements, included in the ACA at the recommendation of NCPA and consumer groups, HHS should issue guidance so that health plans "get an accurate grasp of the complex, multifaceted revenue streams of PBMs that inflate health care costs," NCPA stated. Specifically, in terms of payments to PBMs by manufacturers and other entities, the association suggested a definition of "indirect compensation" to reflect revenue retained by PBMs in addition to rebates.

• Adopt a more transparent process for evaluating proposed changes to plans in the health exchanges than the state plan amendment process currently employed in Medicaid. Proposed changes could be publicly disclosed in advance of HHS' ruling on them, NCPA noted.

"NCPA is committed to continuing to work with policymakers to maximize the health benefits of prescription drugs and other pharmacy services while controlling costs," Hoey added.

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