MEDICAID, BIOTERROR TOP STATE AGENDAS

STEPHANIE LOUGHRAN

ALEXANDRIA, Va. -- State pharmacy associations are striving to make 2002 a year in which they stifle the tightening of Medicaid reimbursement fees paid to pharmacists, create standardized prescription benefit identification cards, and build up emergency protocol procedures in case of bioterroristic threats.

"Our single most important issue is Medicaid reimbursement," Cathy Polley, vice president of state government affairs for the National Association of Chain Drug Stores here, told SN.

State associations are fighting proposals that would decrease the amount pharmacies are reimbursed for providing drugs to Medicaid patients. State legislators have been revising their calculations, using a percentage of the average wholesale price (AWP) of prescription medications.

Officials at some larger state pharmacy associations echoed Polley's concern.

"We are up to our head with issues dealing with Medicaid," said David Gonzales, senior director of public affairs for the Austin-based Texas Pharmacy Association.

To cut costs, the state is focusing on the way pharmacies refill medication, taking a closer look at limiting monthly maximum dosages and restricting lifestyle drugs.

"We used to require 50% use of product before a refill can be made; now it's 75%," Gonzales said. "With the Medicaid program in Texas, the budget has gone so out of whack that anything and everything is on the table, from pharmacist reimbursement to drug pricing, supplemental rebates and prior authorization."

When SN asked why the solutions to reduce the deficit in the health care program for the poor always seem to hit retail pharmacists' pocketbook the hardest, Michael Jackson, executive director for the Florida Pharmacy Association, Tallahassee, said, "They tend to go after the line of least resistance, but they're finding out we're not the line of least resistance."

The Pennsylvania Pharmacists Association, Harrisburg, is urging legislators not to change PACE (Pharmaceutical Assistance Contract for the Elderly), the state program that assists eligible older Keystone State residents with the cost of their prescription medications.

"I've been telling legislators that their proposals are not good proposals and there are other ways to save money without attacking a profession that has been attacked so much," said Carmen DiCello, chief executive officer, PPA.

Legislators in Pennsylvania are also proposing to further reduce pharmacists' AWP reimbursements, and they are looking to utilize mail order for maintenance drugs, which would bypass community pharmacies.

"The key element we're hitting is we're not the culprit of the escalating cost of the drug program. It is the drug manufacturers, and that's where the focus of any form of cost containment should go towards, and not to the pharmacy community," DiCello said.

According to a study released last week by the Centers for Medicare and Medicaid, Washington, spending on health care in 2000 grew by 6.9%, to $1.3 trillion. Prescription drugs were the fastest-growing segment in health care spending, ballooning 17.3% to $121.8 billion in 2000. Third parties paid for 68% of prescriptions in 2000, up from 41% in 1990, the study reported.

DiCello said his association suggests reducing health care costs by being more restrictive with formularies.

Other pressing state legislative issues involve increasing efficiency in pharmacy. Many state pharmacy associations are pressing lawmakers to standardize prescription benefit cards.

"One of the most troublesome things is the insurance cards not having enough information one them," said Jackson of the FPA. He said a uniform identification card that would have all of a patient's insurance information in the same place on every card, regardless of the patient's carrier, would "help pharmacists expedite services instead of being held up waiting for an [insurance] claim to go through."

Another issue concerns pharmacists' role in case of bioterrorism, according to Susan Winckler, group director of policy and advocacy, American Pharmaceutical Association, Washington.

"I think some states will also be looking at bioterrorism response, and building up their public health systems," she said. "We'll be watching to make sure pharmacists play an appropriate role, without getting put into a position where there's little benefit to what they're being asked to do."

State initiatives include permitting more pharmacists across the country to administer immunizations.

In Florida, according to Jackson, there are bills in the pipeline that outline continuing education requirements on bioterrorism for health care providers, as well as allowing for the mobilization of health care providers and giving them an expanded role in mass immunizations.

In Texas, Gonzales said the governor's office appointed a task force made up of nurses, doctors, pharmacists and hospitals specific to homeland security that included health care providers' response to bioterrorism. The final report, which Gonzales said will be ready this spring, will set up response protocols for a biological threat.

Other states are focusing on bills relating to reducing drug errors. Sen. Cheryl Jacques, D-Mass., recently introduced Senate Bill 395, which would enable state regulators to fine druggists up to $5,000 for errors like dispensing the wrong drug.

"This has been getting a lot of attention since there have been a couple high-profile incidents of people receiving the wrong drugs," Jacques told SN. "I think that given that, it's very likely legislators will sit up and take notice and that this bill could pass by the end of the year."

According to Jacques' chief of staff, Angus McQuilken, 41 other states have fining authority for pharmacy errors.

Alan Shubin, president, Massachusetts Pharmacists Association, Waltham, said this law would be a "terrible solution."

"Medical errors in the state of Massachusetts and all across the country is a serious [issue], but it needs to be attacked by education, workflow process adjustment and quality-assurance measures," Shubin said.

With a host of issues that will directly affect business and workflow in pharmacy, state associations are making sure their voices are heard.

"The legislators have a much more open ear to us now. I will say to you that they are listening very, very seriously," DiCello said. "Our message is getting there, but it's not quite there yet."