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Bill would improve payment transparency, pharmacy group says

February 12, 2015
by Lois A. Bowers, Senior Editor
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The Senior Care Pharmacy Coalition (SCPC) has endorsed H.R. 244, also known as the MAC Transparency Act, saying that, if passed, it would improve payment transparency within the Medicare prescription drug program. The legislation was introduced by U.S. Rep. Doug Collins (R-GA) and Rep. Dave Loebsack (D-IA).

Pharmacy benefits managers (PBMs) use maximum allowable cost (MAC) pricing to determine how much to reimburse pharmacies that dispense generic drugs to their covered patients/residents. H.R. 244 would require the MAC lists to be updated every seven days with advance public notice.

“Current pricing practices make it impossible for [long-term care] LTC pharmacies to predict how they will be reimbursed for the generic drugs they dispense under Medicare Part D,” Alan G. Rosenbloom, president and CEO of the SCPC, said in a letter to the congressmen. “PBMs develop and alter their MAC pricing lists without disclosing how they determine which drugs to include on the lists, how those prices are established or how frequently those prices are updated, rendering the process completely opaque,” he continued.

MAC pricing presents challenges to independent LTC pharmacies, for example, because skilled nursing residents, for whom consulting pharmacists employed by LTC pharmacies participate in care planning, take an average of 10 to 13 medications each, Rosenbloom said. “It becomes very difficult, and in some cases impossible, to forecast revenues and to assure resources sufficient to provide the extensive array of services that LTC patients need and deserve and which federal law requires that LTC pharmacies provide,” he added.

The SCPC is a recently formed non-profit advocacy organization representing companies that own and operate independent LTC pharmacies serving more than 325,000 skilled nursing and assisted living residents in about 40 states.

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