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Initiative to Improve Pharmacy Service for Medicare
Drug Program Launched
Less confusion,
less time at pharmacy, faster access to drugs
April 19, 2006 Several associations representing
private insurance, pharmacists and drug stores say they have a plan to
improve the Medicare drug program services by making it less confusing,
speeding up service at the pharmacy and giving senior citizens faster
access to the drugs they need. It will also help pharmacists by
improving communications concerning the status of drugs covered by
Medicare.
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In what is called "an unprecedented joint effort,"
America's Health Insurance Plans (AHIP), the National Community
Pharmacists Association (NCPA), and the National Association of Chain
Drug Stores (NACDS) announced today they have collaborated to simplify
and standardize the steps that most affect service for Medicare
beneficiaries filling prescriptions at pharmacies.
NACDS, NCPA, and AHIP have worked together over the
past six weeks, along with the American Pharmacists Association (APhA)
and the Pharmaceutical Care Management Association, to simplify and
standardize the electronic claims processing messages going from
Medicare Part D drug sponsors to independent pharmacies and retail
chains.
The initial step in this effort was to provide
pharmacists electronic message clarity regarding the coverage status of
certain drugs.
Coverage denials can be grouped into two
categories: drugs that are denied because they are excluded from Part D
coverage as mandated by the Medicare Modernization Act, and drugs that
are denied because they are covered under Medicare Part B.
AHIP, NACDS, and NCPA developed and presented joint
recommendations to a Work Group of the National Council for Prescription
Drug Programs (NCPDP), the organization that creates and promotes
standards for transferring data to and from pharmacies.
NCPDP has approved a process for using standardized
coding and electronic messages notifying pharmacists of claims
rejections in these two situations.
Today, NACDS, AHIP, and NCPA are transmitting to
the Centers for Medicare & Medicaid Services (CMS) and NCPDP a second
set of recommendations to further improve service to Medicare
beneficiaries filling prescriptions at community pharmacies.
The new proposal for additional standardized
electronic claims processing messages to pharmacists addresses prior
authorization requirements, daily dose limitations, quantities that may
be dispensed for a given prescription, and age and gender
contraindications.
"The result of the work between our groups is that
everyone wins," said Bob Hannan, Interim CEO of NACDS.
"Medicare recipients will benefit from this
important collaboration through less confusion, less time at the
pharmacy counter, and faster access to the medications they need.
Pharmacists will also be assisted through improved communication
concerning the status of drugs covered under Medicare."
The success of this unprecedented collaboration
among AHIP, NCPA, and NACDS has led to discussions of how to build on
these cooperative efforts.
"I think we have a unique opportunity to build on
this collaboration between prescription drug plans and pharmacists to
identify additional efforts to improve the Medicare Part D benefit and
build a new model that results in enhanced patient care," said NCPA
Executive Vice President and CEO Bruce Roberts, RPh.
At a news briefing today, CMS Administrator Mark B.
McClellan, MD, PhD, also announced the formation of the Pharmacy Quality
Alliance (PQA). PQA will aim to improve pharmacy care and outcomes
through a collaboration of the pharmacy community, health plans,
government, employers, physicians, and consumers. The goal of PQA will
be to agree on a strategy for measuring and reporting data that will
help consumers make informed choices and appropriate healthcare
decisions.
"Pharmacists and pharmacies have demonstrated how
important they are to the implementation of the Medicare drug benefit,
and we're pleased to support these collaborative efforts," said Dr.
McClellan. "The PQA is an important next step in supporting pharmacists'
efforts to improve quality and reduce costs in our health care system,"
he said.
The founding members of PQA will include APhA,
NACDS, NCPA, and AHIP along with other leading consumer groups, pharmacy
organizations, employer groups, physician organizations, and health
plans.
"Today's health care challenges require that we as
stakeholders roll up our sleeves, remove ourselves from silos, and work
together with new partners and in new ways," said AHIP President and CEO
Karen Ignagni. "No one stakeholder alone can achieve the system-wide
improvements in quality that we hope to achieve together," she said.
About information source:
The National Community Pharmacists Association,
founded in 1898, represents the nation's community pharmacists,
including the owners of more than 24,000 pharmacies. The nation's
independent pharmacies, independent pharmacy franchises, and independent
chains represent an $84 billion marketplace, dispensing nearly half of
the nation's retail prescription medicines.
The National Association of Chain Drug Stores (NACDS)
represents the nation's leading retail chain pharmacies and suppliers,
helping them better meet the changing needs of their patients and
customers. Chain pharmacies operate more than 37,000 pharmacies, employ
114,000 pharmacists, fill more than 2.3 billion prescriptions yearly,
and have annual sales of nearly $700 billion. Other members include more
than 1,000 suppliers of products and services to the chain drug
industry. NACDS international membership has grown to include 93 members
from 30 countries. For more information about NACDS, visit
http://www.nacds.org/.
America's Health Insurance Plans - Providing Health
Benefits to More Than 200 Million Americans
Web sites:
http://www.ahip.org/
http://www.nacds.org/
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