E&C Lets CMS Exempt Long-Term Care Pharmacies From Lock-In, But Facilities Want More

DATE: May 15, 2015

Long-term care pharmacies are pleased that House Energy & Commerce members opened the door to exempting them from the pharmacy lock-in plan in 21st Century Cures legislation, but they prefer to be excluded outright. The third ‘Cures’ draft, which cleared the health subcommittee Thursday (May 14), includes new language suggesting CMS consider exempting long-term care facility residents from the measure that lets plans limit which pharmacies may dispense drugs prone to abuse, such as pain medicine.

The latest version of the bill also codifies that hospice patients are exempt from the so-called lock-in restrictions and lets CMS exempt other categories of individuals as well.

“The bill can and should be further strengthened by making clear that beneficiaries in skilled nursing facilities and other long-term care settings are exempt by legislation rather than subsequent administrative rule,” said Alan Rosenbloom, president of Senior Care Pharmacy Coalition, which represents independent long-term care pharmacies.

Still, he said the revisions are a “significant step in the right direction” because they recognize some beneficiaries should not be covered by the provision because they already are protected by rules governing the facilities that serve them. Rosenbloom told Inside Health Policy that long-term care pharmacies already are subject to regulations stricter than those that would be applied to so-called safe pharmacy networks.

While the primary goal of the Cures bill is to speed approvals of breakthrough drugs and medical devices, the committee has long been concerned with abuse of prescription drugs and plans to talk with state health officials about the problem next week.

Seniors’ advocates and long-term care pharmacies support drug-abuse prevention, but they worry the pharmacy lock-in measure in the Cure’s legislation would make it difficult for beneficiaries to obtain vital medicine.

The second draft added a beneficiary-appeals measure, but lobbyists for seniors and long-term care pharmacies said that was insufficient. While the third draft went a step further by exempting hospice patients and suggesting CMS consider exempting long-term care facility residents and others, long-term care pharmacies are still worried they could get snagged by the restrictions. — John Wilkerson (jwilkerson@iwpnews.com)

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