PharmQuest

Obama Signs Health Care Reform Bill--Some Provisions Impact LTC Pharmacy

President Obama signed historic health care reform legislation on March 23, paving the way for major changes in our health care system over the next ten years.  Still unknown is whether the Senate will approve a package of amendments reflecting provisions already passed by the House of Representatives.  The bill signed by the President today is massive, well over 2000 pages.

As signed by the President, over the next decade, the Patient Protection and Affordable Care Act will expand health insurance coverage by requiring most Americans to purchase health insurance or pay a penalty.  An estimated 24 million Americans will be eligible for subsidies to purchase insurance through new state-based exchanges, employers with more than 50 employees will be required to provide insurance and just about everyone with income below 133 percent of the federal poverty level with be eligible for Medicaid.

For pharmacists, there is good news and bad.  ASCP worked to secure language in the bill to ensure that pharmacists were included in new health care delivery models such as the Independence at Home program and medical homes.  Inclusion of pharmacist-provided medication therapy management services in medical homes will be supported by a new grant program and Part D MTM is strengthened.  Over the next ten years, the Part D coverage gap will be closed, beginning with a $250 rebate to beneficiaries in 2010 and continuing with discounts for brand name and eventually for generic drugs.  These discounts will be paid by the pharmacy at point of sale.  Dual-eligibles in waiver programs will be treated like institutionalized duals and pay no co-payments. 

The most troubling provision is a requirement that the Secretary require Part D plans to utilize specific utilization management techniques including short-cycle and automated dispensing.  This provision is intended to reduce pharmaceutical waste in long-term care and was estimated to save the federal government nearly $6 billion.  All of our analysis suggests however that the costs of dispensing on a 7-day cycle go up for pharmacies (and for payors).  As noted below, at a recent meeting hosted by NCPDP, devising a workable system will be a formidable task. ASCP will continue to push for changes in this legislation and to work with CMS to ensure that implementation is not done at the expense of long-term care pharmacies.

ASCP is developing a more detailed analysis of the health care reform legislation.  Please continue to read ASCP Insider for more information.