Maryland Senators Ben Cardin and Barbara Mikulski deserve credit for strong teamwork helping to ensure the Centers for Medicare & Medicaid Services, thankfully, took recent action to protect vulnerable seniors, and reduce Medicare waste.
In skilled nursing and other care settings across the nation, medically compromised seniors and patients facing rehabilitation significantly benefit from the clinical oversight independent long term care pharmacies provide. Among a variety of key responsibilities, LTC pharmacies are accountable for compliance with increasingly complex medication and care management regimes, and the professional review process essential to prevent potentially deadly adverse drug reactions and other complications that can result from insufficient medication and care management.
As with many CMS matters, provider reimbursement issues require fine-tuning. Such is the case here, with so-called “Daily Dispensing Fees.” Traditionally, LTC pharmacies receive a flat professional fee for each prescription they fill. This professional fee covers all activities associated with filling a prescription, including clinical review by a pharmacist to ensure safety, and the labor associated with assembling and delivering the medication. These actions require the same level of professional care, oversight and service – regardless of the quantity of medication dispensed.
The problem began when the nation’s two largest Pharmacy Benefit Managers – third party entities that oversee the administration of seniors’ Medicare prescription drug benefits – abandoned flat, professional dispensing fees. They instead tied the fee to the quantity of medication dispensed. This move ignored the clinical oversight necessary to fill a prescription, thus placing at risk the ongoing provision of quality patient care and safety, and incentivizing inefficient, wasteful drug dispensing.
Senators Cardin and Mikulski introduced the Medicare Efficient Drug Dispensing Act (S. 1493) in 2014 to restore the professional dispensing fee, and encourage the use of dispensing techniques that foster efficiency and reduce waste. Specifically, the legislation would have prohibited Medicare Part D plan sponsors from using prorated daily dispensing fees that discourage the adoption of techniques designed to minimize the dispensing of unused drugs. The Senators also worked diligently to persuade CMS to act directly to end this practice. Their hard work paid off.
CMS, to its credit after reviewing the facts at hand, has now prohibited the use of prorated dispensing fees by PBMs. The Cardin-Mikulski bill, in effect, helped drive this regulatory prohibition and focused needed attention on a complex health policy matter that, when closely examined, helps protect the safety of patients and promotes Medicare spending efficiency. Senators Cardin and Mikulski deserve recognition and praise for this effort, and for their strong, lengthy record of preserving, protecting and defending the health interests of America’s seniors.
Alan G. Rosenbloom is President/CEO of the Senior Care Pharmacy Coalition (SCPC) in Washington, D.C. The SCPC represents companies that own and operate independent long-term care pharmacies in roughly 40 states, serving over 325,000 residents in skilled nursing facilities and assisted living facilities.