Saying new bipartisan legislation introduced by U.S. Reps Doug Collins (R-GA) and Dave Loebsack (D-IA) will advance payment transparency within the Medicare prescription drug program, the Senior Care Pharmacy Coalition (SCPC) today endorsed H.R. 244, the MAC Transparency Act.
“Current pricing practices make it impossible for LTC pharmacies to predict how they will be reimbursed for the generic drugs they dispense under Medicare Part D,” states Alan G. Rosenbloom, President and CEO of SCPC, in a new letter to Reps. Collins and Loebsack. “Pharmacy Benefit Managers (PBMs) use Maximum Allowable Cost (MAC) pricing to determine how much to reimburse pharmacies that dispense generic drugs to their covered patients. PBMs develop and alter their MAC pricing lists without disclosing how they determine which drugs to include on the lists, how those prices are established, or how frequently those prices are updated, rendering the process completely opaque,” Rosenbloom continues.
“We specifically applaud your introduction of H.R. 244, the ‘MAC Transparency Act,’ which seeks more equitable and transparent reimbursement for pharmacies dispensing generic drugs to seniors,” he states. The SCPC Pres/CEO explains that MAC pricing presents particularly serious challenges to independent LTC pharmacies: “It becomes very difficult, and in some cases impossible, to forecast revenues and to assure resources sufficient to provide the extensive array of services that LTC patients need and deserve, and which federal law requires that LTC pharmacies provide.”
For example, Rosenbloom notes the typical resident in a skilled nursing facility averages 10 to 13 prescription medications. Consulting pharmacists, employed by independent LTC pharmacies, must participate actively in care planning for each patient, including assuring that medications, dosages, and combinations of medications are appropriate and avoiding unnecessary adverse drug interactions or other untoward—and costly—events that, in many cases, may result in a hospital readmission. “With the recent significant price increases of generic drugs, these challenges have become more acute, particularly given that more than 80 percent of medications dispensed to Part D beneficiaries in LTC settings are generics,” he says.
Continues the letter: “The SCPC is encouraged by the steps your legislation takes to ensure that the method of determining MAC reimbursement rates is clear and appropriate. In an era of sharply rising generic drug costs, the pharmacy industry is plagued by a lack of responsiveness by the PBMs to adjust MAC prices to reflect the increase in acquisition cost. We are particularly pleased that H.R. 244 requires MAC lists to be updated every seven days with advanced public notice. Increased transparency is a step in the right direction to enable independent LTC pharmacies to maintain the level of service Medicare beneficiaries deserve and the law and regulations require.”
The SCPC is a recently formed non-profit advocacy organization, representing companies that own and operate independent long-term care (LTC) pharmacies across the nation. These pharmacies serve more than 325,000 residents in skilled nursing facilities and assisted living centers in approximately 40 states – with most relying upon Medicare Part D to pay for the medications vital to their health care and well being.