MPARX

Maine Pharmacy Association

DHHS shared guidance documents for e-prescribing and opioid dispensing

DHHS shared guidance documents for e-prescribing and opioid dispensing.  Notably, “A pharmacist is NOT required to verify that a practitioner has a waiver of the requirement to electronically prescribe…” To review the official documents, please click on the links below. Electronic-Prescribing-Clarifications Opioid Dispensing Clarification    

E-Prescribing Grace Period Notice and Chapter 488 User Guide

The deadline for mandatory e-prescribing of opioids was rapidly approaching on July 1st. However, the State sent the following communication announcing a 31 day grace period for enforcement of the penalties for violating the e-prescribing provision.  This is good news and will give prescribers and dispensers a little more time to prepare. DHHS provided material on other provisions in Chapter […]

2017 Scholarship Golf Scramble

Join us for our 2017 Scholarship Golf Scramble ! Where: Val Halla Country Club When: Saturday, August 12, 2017 Shotgun start 1pm Includes 18 holes of golf on a championship course, golf cart, BBQ dinner at Rachel’s on the Green! Cost: Single Golfer: $110.00 Foursome: $400.00 Dinner Only: $35.00 Corporate or personal hole sponsorship: $75 […]

Pharmacists from across Maine convene in Augusta to advocate for profession and patients

Pharmacists and pharmacy students from across the state convened in Augusta on May 30th to advocate for LD 572.   Update: Senate passes LD 572; now on to the House!  LD 572 specifies in statute that the “Practice of Pharmacy” is “the provision of health care services” and that “Pharmacists” are “providers of health care services”. […]

LD6 and LD44 Are Successfully Moving Through the Legislative Process

Good news!!  Two bills, LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” and LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” are moving through the legislature process. LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on […]

Good news!!  Two bills, LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” and LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” are moving through the legislature process.

LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” has passed the Maine Senate and Maine House and is on the way to the Governor’s desk.   The Maine Pharmacy Association advocated for this bill.

What are Retroactive Payment Reductions?  In theory, calculating the profit from dispensing a prescription should not be difficult.  However, retroactive payment reductions such as Direct and Indirect Remuneration (DIR) fees are complicated charges that are billed to pharmacies often many months after a clean claim for a prescription has been submitted.  These charges may be the difference between the agreed upon reimbursement rate and another contractual variable or these fees may be based on compliance with contractually imposed performance metrics.  These retroactive fees, which began as a component of Medicare Part D plans, have expanded and are now incorporated in many commercial third party plans.
 
How does this affect pharmacy?
“DIR fees have wreaked havoc on independent community pharmacies and their ability to continue serving patients. These fees, typically assessed by PBMs well after prescriptions are dispensed to patients, blow a hole in community pharmacy operating budgets that is difficult to mend,” Doug Hoey, CEO of NCPA January 20, 2017
 
The growth in DIR fees is outpacing the growth of part-D drug costs and DIR fees have expanded to many commercial third party plans.  DIR fees have yet to show that they improve performance and specifically patient outcomes.  DIR fees do not reduce the cost of drugs for beneficiaries at the point-of-sale and in fact push seniors (especially vulnerable patients who use the prescription drug benefit the most) into the ‘donut hole’ and even further into the catastrophic phase of the Part D benefit.  As implemented, DIR fees are shifting the burden of drug costs away from the private insurance companies and onto the backs of local pharmacies.   LD 6 is a win for the profession because it requires fair reimbursement for clean pharmacy claims.

LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” received a unanimous ‘ought to pass’ as amended from the Health and Human Services Committee.  The amended bill would add the following to the definition of “Practice of Pharmacy”… “the provision of tobacco cessation, ordering and dispensing of over-the-counter tobacco cessation products approved by the United States Food and Drug Administration”.

This bill is good public health policy because it increases access to smoking cessation products and services. A unanimous ought-to-pass from the committee is a significant step forward in the legislative process.  We’ll continue to monitor this bill through the legislature and to the Governor’s desk.

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