MPARX

Maine Pharmacy Association

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 […]

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 […]

Achievement Award Nominations

MPA would like your assistance in nominating persons worthy of these honors to be recognized at the Sesquicentennial Awards Ceremony at the Holiday Inn By the Bay, October 13-15, 2017.  To nominate a person, please complete the nomination form and submit by June 1, 2016. MPA Award Nomination Form **NEW** Douglas H. Kay Distinguished Pharmacy Educator Award Sponsored […]

IMPORTANT Augusta Legislative Update – Time to Advocate!

NOW is the time to advocate for your profession!  Details about how YOU can get involved are outlined below. I’m delighted to report that a date for a public hearing has been set for LD 572, An Act to Amend the Laws Governing the Practice of Pharmacy, and LD 456, An Act to Increase Access to […]

CDC OPIOID PRESCRIBING GUIDELINE MOBILE APP

Opioids can have serious risks and side effects, and CDC developed the CDC Guideline for Prescribing Opioids for Chronic Pain to encourage safer, more effective chronic pain management. CDC’s new Opioid Guideline App makes it easier to apply the recommendations into clinical practice by putting the entire guideline, tools, and resources in the palm of […]

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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