Congressional Community Pharmacy Coalition
CONGRESSIONAL COMMUNITY PHARMACY COALITION
PRESERVING PATIENT ACCESS TO AMERICA’S MOST ACCESSIBLE HEALTHCARE PROFESSIONALS
COMMUNITY PHARMACISTS SERVE THE COMMUNITY:
• Over 23,000 independents nationwide
• Provide over 300,000 small business jobs
• Provide prescription access which keeps our workforce, seniors and children healthy
• In smaller communities, pharmacies are the primary health care resource
KEY COMMUNITY PHARMACY ISSUES:
MEDICAID AND AMP
H.R. 3140, THE SAVING OUR COMMUNITY PHARMACIES ACT
• Patients will lose pharmacy access as providers will be driven from Medicaid by a new Federal
Upper Limit (FUL) for multi-source, generic prescription drugs based on Average Manufacturer
Price (AMP) which falls 36% below pharmacy acquisition costs (Source: GAO-07-239R, 1/20/2007)
• AMP must cover acquisition costs paid by community pharmacy
• Loss of access will increase taxpayer costs from more doctor visits, emergency room treatments
and long term care costs
• To increase savings, Medicaid must encourage generic utilization
MEDICARE PART D AND PROMPT PAYMENT
H.R. 1474, THE FAIR AND SPEEDY TREATMENT OF MEDICARE PRESCRIPTION DRUG CLAIMS ACT
• An August 2007 University of Texas Study has found:
o Only 1.3 percent of electronically submitted Part D claims are electronically reimbursed
within two weeks of adjudication (the standard for similar Medicaid claims)
o At 30 days, Half of community pharmacy claims remain unpaid
o At 60 days, One in six claims—17.2%—remain unpaid
o Most plans choose to reimburse via paper check through “snail mail” causing further delays
• Prompt Payment – To ensure continued patient access, providers should be reimbursed
electronically within 14 days for clean claims submitted electronically
PBM ABUSES AND NEGOTIATION RIGHTS
H.R. 971, THE COMMUNITY PHARMACY FAIRNESS ACT
• PBMs lack transparency, yet make millions from government and third-party contracts
• Shrinking and shifting formularies (list of drugs covered) restrict treatment options
• Redundant pre-authorization hassles generate red tape for patients, pharmacists and doctors
• 90-day prescriptions at retail are restricted as PBMs insist patients use the PBM-owned mail
order facility (a conflict of interest)
• PBMs bill employers for more than they pay the pharmacy and pocket the difference
• H.R. 971 would allow independent pharmacies the ability to negotiate their Part D and other
third-party contracts
• Negotiation rights require NO government funding
NCPA Government Affairs: 703-683-8200
