The Senior Care Pharmacy Coalition (“SCPC”) appreciates the opportunity to provide the following comments to the Center for Medicare and Medicaid Service’s (“CMS”) draft 2017 Part D Call Letter, dated February 19, 2016 (the “Call Letter”).
The SCPC is the national association representing independent long-term care (“LTC”) pharmacies. Our member pharmacies provide care and services to patients in long-term care facilities in more than 40 states who occupy approximately 400,000 beds across the country. The SCPC advocates for public policies that protect patients, improve the quality of healthcare across a shifting care continuum, and strengthen the economic viability of independent LTC pharmacies and their ability to serve medically compromised seniors.
LTC pharmacies – sometimes called “closed-door” or “institutional” pharmacies – are a distinct subset within the pharmacy community, and are a critical provider of medications on behalf of the Part D program. Skilled nursing facilities (“SNFs”) and nursing facilities (“NFs”) typically contract with a single LTC pharmacy to prepare and dispense prescription drugs for individual patients, and to provide an array of consulting pharmacy and care planning services required by Medicare, Medicaid, state licensure laws, and professional standards. As CMS is aware, its regulations specifically address and define “long term care pharmacy,” 42 C.F.R. § 423.100 (”Definitions”) and both statute and regulation require that LTC facilities through long term care pharmacies “provide routine and emergency drugs and biologicals to [their] residents, or obtain them under an agreement described in [42 C.F.R. § 483.75(h)].” See 42 U.S.C. §§ 1395i-3(a) and 1396r(a)(4) (“Provision of Services and Activities”); 42 C.F.R. § 483.60 (“Pharmacy Services”). Medications, including Part D drugs, must be “administered in a manner than enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being” of beneficiaries residing in SNFs. Thus, in light of the specific statutory and regulatory regime surrounding LTC pharmacy, we bring a unique perspective on the draft Call Letter.
As set forth in more detail below, we urge the Agency to revisit and amend the Call Letter to address: (1) network adequacy, where we urge CMS to adopt clear LTC network adequacy standards; (2) prior authorization, where we recommend appropriately tailoring the formulary management technique in the case of LTC pharmacy and data collection on payment for interim fills while requests are pending; (3) medication therapy management, where we commend CMS for its active encouragement of MTM and suggest even greater expansion of the MTM program; (4) opioid issues, where we welcome opioid utilization and control efforts, and urge CMS to carefully apply such analysis to the appropriate care settings; and (5) MAC pricing issues, where we urge CMS to collect data on Plan compliance with new price reporting requirements. Our specific comments follow.