November 2012 - Northeast Pharmacy Service Corporation

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NEW NETWORK PARTICIPANTS Cornerstone Pharmacy, Stamford, CT Neighborhood Healthmart Pharmacy, Methuen, MA Salem Health Mart Pharmacy, Salem, CT Continued from page 1 company did not have. The Board issued an immediate cease and desist and quarantine notice. Subsequently, the company voluntarily surrendered its pharmacy license. NCPA has reported that Congress is considering the options relating to pharmacy compounding. Both the House and Senate Committees which have jurisdiction over this matter are currently conducting investigations. NCPA believes that it is likely that both will hold a hearing to further examine the tragic outbreak during the “lame-duck” session after the election. Congress is also interested in hearing pharmacy groups’ views on whether the FDA needs more authority to regulate compounding, and potential legislative options to address the current situation. States are also looking at possible actions, such as tightening up rules relating to pharmacy compounding and increasing inspections. What is happening in your state? Keep your eyes and ears open. The disaster keeps getting worse. Medicare began a program in October that penalizes hospitals for high re-admission rates. Poorly performing hospitals can lose 1% of their payments this year and 2% next year. This initiative focuses on congestive heart failure (CHF), acute myocardial infarction (AMI), and pneumonia (pneumonia). In most quarters, patient compliance with discharge orders and medications are seen as the weak links to be mended. Some larger hospitals actually will use their outpatient pharmacies to become more involved with managing and monitoring these patients. There is even some federal grant money around. But smaller community hospitals will not have access to the kind of pharmacy resources they need. This means that you might have the opportunity to become a critical partner with your local hospital pharmacy Director. Find the name of that person and talk to them. If you don’t think this is a viable business, consider this: Walgreens has undertaken this initiative with about a dozen hospitals. It is called Well Transitions. Fax requests for continuation of therapy on controlled substances Class III–V. We try to make it crystal clear: PHARMACIES MAY NOT SEND A FAX RE- QUEST THAT FILLS IN THE PRESCRIPTION AND NEEDS ONLY THE PHYSICIAN SIGNATURE. Most software systems have already made the necessary changes or will Continued on page 3 2 NETWORK NEWS - NOVEMBER 2012
Continued from page 2 make them soon. The chains are all sending the same message to the doctors’ offices that we are. We have found that there are a significant number of pharmacies using CSOS where only the subscriber (usually the owner) is authorized to order online. We found a significant number that had filled out power of attorneys and had them on file in the store; authorized employees were using the subscriber’s key. Only a few stores had done it correctly. They filled out the Power(s) of Attorney, and submitted it with all required documentation to the DEA for approval. Each authorized person was provided their own “key” to order on the CSOS system. The wholesalers were the ones who pointed out that there were inspections by the DEA and fines being issued in New York State. DEA inspections will be coming to New England. Violations can cost $10,000 per line. This can be fixed pretty simply. You will find that your wholesaler that set you up on CSOS will be well experienced in expanding the number of authorized users. They’ll be happy to help. The chains have been pre-filling prescription refills. We have heard that nearly every chain pharmacist is under enormous pressure to pre-fill maintenance meds and then call the patient to tell them it is ready. It would be one thing if the patient had opted into this kind of adherence program. But it is a starkly different matter when the patient has not initiated the refill in a federally funded program. We have read that the Justice Department, the Department of Health and Human Services, and the states of New Jersey and California are investigating claims that CVS/Caremark filled and billed without the approval or knowledge of the patient. Since this was first published in the Los Angeles Times, the newspaper subsequently reported that Target, Rite Aid, and Walgreens are also doing this. They are all denying this practice and any pressure or quotas on their pharmacy personnel. There is the potential for this to be really painful. Of course, there is much more that was discussed at the dinner meetings. We hope that you will be able to attend future meetings. SXC dba Catamaran By David Benoit Catamaran was formerly known as SXC. SXC sometimes referred to itself as Informed Rx. In the last year or more leading up to the name change, SXC took over NMHCRx, MedMetrics, Innoviant, and Catalyst, which had just bought Walgreen Health Initiatives. The name change might help employees to have a common name for their employer. But the amalgam of companies is not an organized, efficient model of scale; it is a disorganized, dysfunctional collection of parts that have been aimlessly cobbled together. There does not even appear to be a central command. That opinion might sound harsh but it is honest. In mid-July, Catamaran turned on a mandatory 90-day fill for maintenance medications for the Mass Neighborhood Health Plan, initially operated by MedMetrics. At the same time, it appears that Catamaran implemented a MAC list that goes well below anything we have ever seen. Hundreds of pricing appeals were sent to challenge below cost reimbursements. So far, only one owner has told me that a price actually was adjusted. That’s not really a cause for celebration because the adjustment only ameliorated the problem. Instead of losing $20 on a 90-day supply, the store only loses $13 now. For the rest of the appeals, owners are still waiting to get a response or have been told that the MAC will not be changed. It gives us no solace to learn that Neighborhood Health Plan had a record setting year financially. Now with that as background, think what Rhode Island pharmacists can look forward to. BCBS-RI is finally getting rid of CVS/Caremark. That must be proof that there is a higher power looking after us. Or is it? The new PBM for BCBS-RI is Catamaran! I hope I’m wrong. NETWORK NEWS - NOVEMBER 2012 3
Page 1: Network News WWW.NORTHEASTPHARMACY.
Page 5 and 6: $12.19 cost to dispense a prescript
Page 7 and 8: Alert Your New Vendors! By Dianne S
Page 9 and 10: Medicare D Update By David Benoit A
Page 11 and 12: By Pat Monaco NPSC Purchasing Progr

November 2012 - Northeast Pharmacy Service Corporation

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