Moving the HME Industry Forward


Legislative Update – HR 1717, Community Pharmacy, and the Sting

November 25, 2013

WASHINGTON, DC – The determined grassroots advocacy of HME stakeholders around the nation continues to pay off as more members of Congress sign on as cosponsors of H.R. 1717, the legislation to replace competitive bidding with the market pricing program alternative.

The latest two additions are Reps Ann Kuster (D-NH) and David Scott (D-Ga). 

AAHomecare officials are asking all providers to contact their Representative about H.R. 1717 as soon as possible. If your Rep promised to sign on to the bill and is not yet listed as a cosponsor, see congressional contact information here and follow up with staff members.

Behind Closed Doors: CMS Acknowledges Flaws in the Bidding Program
A message from Tom Ryan (pictured), president and CEO of AAHomecare, confirms that CMS met with Senate staffers last week and “acknowledged at least one problem with the bidding program.”

The “one problem” is suppliers not servicing entire bid areas. “Apparently, the agency is aware there are problems and has been running sting operations where they pose as Medicare patients from far-flung communities and test whether the providers are willing to service patients that are living in these less populated communities,” writes Ryan. “When suppliers are not providing services, they start an education process in which they remind the company leaders and staff of the contractual requirements and then continue monitoring the suppliers. CMS maintains that repeated violations will result in the termination of contracts.”

As for more than “one problem,” Ryan laments that the agency continues to downplay the extent of the program’s many serious flaws. “Since the expansion to 91 new areas on July 1, CMS contends that it has only received about 120 beneficiary complaints,” writes Ryan. “…Both providers and stakeholders have been stunned that CMS claims to have received so few complaints from Medicare patients. We know that patient health is being jeopardized by the bidding program, and that providers are needlessly facing financial strains because of the troubling bid process.”   

Abusive Pharmacy Auditing Practices in Spotlight
With the support of the National Community Pharmacists Association (NCPA), Reps Doug Collins (R-Ga) and Martha Roby (R-Ala) sent letters to leaders of the House Energy and Commerce Committee and Ways and Means Committee. The letters had a clear message: community pharmacies should be subject to the same 3-year audit review period as hospitals, and not forced to document 10-year-old claims.

“Patients rely on their independent community pharmacists to ensure proper medication use, to guard against drug interactions and to help take advantage of lower-cost generic drugs, where appropriate,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “These pharmacists should not face needless distractions to patient care such as documenting why they filled a prescription a decade ago. We appreciate Reps. Collins and Roby taking the time to not only meet with some of the pharmacy small business owners that they represent, but for also registering their concern with the appropriate committee leaders.”

Rep Collins wrote, “A few weeks ago I was back in my district and had the opportunity to visit with several small pharmacy owners and their employees about issues they face and deal with every day. It was very concerning for me to hear the struggles and lack of leverage these constituents face when conducting business with large pharmacy benefit managers.”

“One could question why PBMs need ten years to begin an audit,” Rep Roby wrote. “Precedent for a shorter look back already exists within the Medicare RAC process.” She also urged the committees to examine PBM auditing methods, a shorter look back period and what percentage of funds recouped from pharmacies by auditors are actually returned to the Medicare trust fund. In addition, Rep. Roby expressed concern that “pharmacies are frequently reimbursed below their cost to dispense drugs” and that PBM payment benchmarks for generic drugs are not updated frequently enough to avoid “artificially decreasing pharmacy drug reimbursements.”