Medicaid May Require Doctors To Use Tamper-Resistant Paper For Nonelectronic Prescriptions

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State Medicaid directors and more than 100 organizations on Mondayplan to send a letter to congressional leaders to seek a one-year delayof a rule that will require pharmacists to reject paper prescriptionsfor Medicaid beneficiaries not written on tamper-resistant paper,according to Martha Roherty, director of the National Association of State Medicaid Directors, USA Todayreports. The rule, part of a supplemental appropriations bill formilitary operations in Iraq and Afghanistan enacted earlier this year,will take effect on Oct. 1.

According to critics, the rulecould affect access to medications for Medicaid beneficiaries and forcepharmacies to return reimbursements when they fill prescriptionsimproperly. Jamila Edwards of the California Primary Care Associationsaid, "Nobody really knew where this came from," adding, "The patient'sgoing to be in the middle thinking, 'How come I didn't get mymedication?'" Washington state Medicaid Director Doug Porter said, "Inour state, very few doctors use these kinds of pads," adding, "I thinksome people will be denied service, and that will be a very badsituation."

However, Jeffrey Kelman of CMS said that the rulewill allow pharmacists to fill prescriptions not submitted ontamper-resistant paper, provided that they obtain confirmation from thephysicians who wrote the prescriptions by telephone, fax or e-mailwithin three days. He added that the rule should help to preventoverdoses and other problems caused by fraudulent prescriptions (Wolf, USA Today, 9/17).

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Pharmacy Reimbursements

In related news, Rep. Frank Pallone (D-N.J.) might introduce legislation to revise a rule recently finalized by CMS that will reduce Medicaid reimbursements to pharmacies for generic medications, according to a congressional source, CongressDaily reports (Edney, CongressDaily, 9/14).

Therule, mandated by the Deficit Reduction Act of 2005 and scheduled totake effect on Dec. 30, seeks to ensure that Medicaid can obtainprescription drug discounts similar to those obtained by privateentities. The rule will redefine the average manufacturer price forbrand-name and generic medications. States use AMPs to calculateMedicaid reimbursement rates for medications. Under the rule, thefederal government will post AMPs on a Web site that consumers couldaccess. In addition, the rule will limit the federal share of the costof brand-name medications when at least three generic versions areavailable. The rule will exclude pharmacy benefit managers, andpharmacies in nursing homes and assisted living facilities. Accordingto CMS, the rule will save the federal government and states $8.4billion over the next five years (Kaiser Daily Health Policy Report, 7/10).

According to the source, Pallone might introduce legislation similar to a bill (S 1951)sponsored by Sen. Max Baucus (D-Mont.) that would exclude mail-orderpharmacies from the rule and exclude rebates and discounts not providedto pharmacies from the calculation of AMP. The bill sponsored by Baucusalso would increase Medicaid reimbursements for medications to 300% ofAMP from 250%. Pharmacies, which maintain that the rule will preventtheir participation in Medicaid, said that they support the bill.

Charles Sewell, vice president of government affairs for the National Community Pharmacists Association,said, "Right now, our biggest concern is getting something passedbecause there's a ticking time bomb when this goes into effect inJanuary." Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores, said that the bill represents a "much better policy than exists today" (CongressDaily, 9/14).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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