CEO Message June 27, 2008
Author: Lynn Rolston
Dear Member,
Urgent Alert
Yesterday, many pharmacies in California received a letter by fax from DHCS. This letter was sent to pharmacies in error. I spoke with representatives from EDS and DHCS and was able to confirm that this letter will be used for institutional providers after July 1. The following statement from DHCS also confirms that pharmacies are a federally protected provider and will continue to receive payments even if the state does not have a budget.
“Yes, you are correct that Medi-Cal pharmacy providers will continue to be paid during a state budget impasse and during the payment hold in August. Medi-Cal pharmacies and pharmacists are considered non-institutional or practitioner providers and, as such, are federally mandated to receive timely payments under the Medi-Cal program. The August Hold only applies to Medi-Cal “Institutional” providers. Thus Pharmacies and Pharmacists are exempt from the August Hold because they are considered non-institutional providers.”
If you have any additional questions, please contact me by email or by phone.
Budget Update
Legal Action:
1) The Lynn Carman lawsuit motion for preliminary injunction was held on June 23. Unfortunately, their motion was denied based on the judge’s assessment that the plaintiffs did not have “standing” to bring this action. The plan is to move ahead and file an appeal in the 9th Circuit. We are holding out hope that this appeal will be successful in the coming weeks. 2) The CMA vs. Shewry lawsuit was remanded back to state court and the hearing for this case will be held on July 25 in Los Angeles Superior Court. We still have high hopes that this suit will be successful. We will keep you informed as progress is made. 3) On Thursday, the Farmacia Remedios vs. Shewry lawsuit (this is the suit brought by eight California pharmacies) was successful at its hearing to remand the case back to state court. We are now waiting for a hearing date and will let you all know as soon as possible. We had hoped that our hearing date would be held on this coming Monday, but it now looks doubtful. Therefore, at this point, it looks like the ten percent cuts will go into effect on July 1 according to law. All of these lawsuits represent an incredible effort by members, attorneys, involved organizations and concerned individuals. We have received a tremendous amount of press and attention from legislators as a result. We still have a great chance to be successful on one or more of the suits. Stay tuned.
PR Efforts
We have now collected over 150,000 petition signatures and the Governor has seen every one of them. Individual legislators have received district specific signatures. If you have not participated in this effort, we still need your help. You can visit www.calaccessrx.org to download petitions for your patients to sign. Until this issue is settled, we need to continue our fight. Additionally, more and more patient advocacy organizations continue to join our coalition, Patients for Access to Medicines. And, we will be ramping up our press efforts and other activities over the coming days.
Funding
We received great news this week from the Coalition for Community Pharmacy Action, a joint effort by NCPA and NACDS, who voted to contribute $75,000 to our legal effort to stop these cuts. We are extremely grateful for this assistance!!!
Update: Medi-Cal Managed Care Plans
It has come to our attention that there are a few Medi-Cal Managed Care plans that are NOT planning to pass on the ten percent reduction that they will experience to their pharmacies. We want to thank the Health Plan of San Joaquin, San Mateo Health Plan and CalOptima for taking this action to preserve their pharmacy networks and the health of their patients.
However, we are sorry to report that Anthem Blue Cross will implement the fee schedule changes effective July 1 to reduce provider fees.
Medi-Cal Checkwrite
On June 24, the DHCS announced that Medi-Cal providers will receive an additional checkwrite that will be issued on June 26. This checkwrite is possible because Medi-Cal expenditures have come in sufficiently under budget. The June 26 checkwrite will be for claims that would have been paid by the June 19 checkwrite. In addition, the DHCS confirmed that Medi-Cal providers, including pharmacies, will continue to be paid after July 1 even if a state budget is NOT enacted. CPhA is seeking confirmation from DHCS that pharmacies will continue to be paid throughout any period without a state budget and will not be subject to delays in payments that are planned for institutional providers.
HR 6331
CPhA would like to thank our national associations, NCPA, NACDS and APhA, for the tremendous effort they put in to pass HR 6331. The bill contained some very positive pharmacy provisions including instituting a program of electronic prescribing in Medicare, ensuring that pharmacies in the Medicare Part D program are reimbursed in a timely fashion and providing a delay in the implementation of the competitive bidding program for durable medical equipment (DME). We know that a great number of our members participated in this effort as well. And, while the bill did not achieve cloture in the Senate yesterday, the effort has moved the cause of pharmacy ahead substantially. We should all stand ready to help when these issues come again before Congress.
The Michael L. Huston Award for 2007
Congratulations to I.R.Patel who was awarded United Drugs’ 2007 Michael L. Huston Award. This prestigious award serves to recognize member pharmacists who have contributed to the success of the cooperative, the pharmacy profession and to their community. I.R. is truly deserving of this award as he has for years championed causes for the profession.
California Hospital Association (CHA) Advertising Campaign Launched This Week
CHA has launched an ad campaign as part of its public advocacy program that will consist of TV and targeted newspaper ads throughout the state, with the goal of driving voters to a new website - www.SaveMyEmergencyRoom.com. Like our coalition, Patients for Access to Medicines, CHA is utilizing the website as tool where concerned Californians can sign a petition to be delivered to the Governor and the legislature.
California Medical Volunteers - Reminder
Given the 800 fires burning throughout California this week, we’d like to take the opportunity to encourage pharmacists to register as medical volunteers with the State of California so that they can be deployed in the event of a disaster. Click here to learn more. The online registration process is simple and won’t take long.
NASPA and SureScripts Collaborate on PEER Portal
NASPA and SureScripts announced a collaborative effort to gather direct input from practicing community pharmacists and technicians about the experiences that they have had with electronic prescriptions. This initiative, which compliments the patient safety focus of NASPA’s ongoing Pharmacy Quality Commitment program, is designed to allow the two organizations to gather detailed, actionable, non-PHI data about issues that have been encountered with electronic prescriptions so that said issues can be traced, analyzed, and if appropriate, remediated. Depending upon the circumstances, these efforts might then lead to process improvement bulletins, new certification requirements, best practices, and if necessary, interventions with prescriber and pharmacy application vendors. It is hoped that the widespread use of the Pharmacy E-prescribing Experience Reporting Portal (PEER Portal) will lead to continuous innovation and quality improvement within e-prescribing processes on a national basis. To learn more, click here.
New Training Program on Dealing with Errors
As part of the Pharmacy Foundation of California’s efforts to fight medication errors, we would like to inform you about a new training program designed for your entire staff. The purpose of the program is to foster a “just culture” within your organization, which will make frontline personnel feel comfortable disclosing errors—including their own—while maintaining professional accountability. A “just culture” recognizes that every professional will make mistakes and acknowledges that even competent professionals will develop unhealthy norms (shortcuts, “routine rule violations”), but has zero tolerance for reckless behavior. To obtain more information about this program and see if it might be right for your organization, please visit www.safechoicestraining.com.
FDA Drug Disposal Guidelines
The FDA recently released guidelines for the proper disposal of medications. You can download the guidelines here.
In the News
The Inland Valley Daily Bulletin ran an article highlighting the impact the Medi-Cal cuts will have on a local pharmacy. To read the story, click here.
The Modesto Bee carried an opinion editorial by Harry L. Foster, CEO of Family Healthcare Network. The opinion editorial focused on why Medi-Cal cuts are unacceptable. You can read the OpEd here.
Assembly member Bill Emmerson is quoted in an article saying he thinks lawmakers could save money by changing Medi-Cal services and eligibility rather than making systematic cuts. Here’s an excerpt: The Inland health maintenance organization that handles Medi-Cal coverage for nearly 350,000 low-income residents in Riverside and San Bernardino counties will slash or stop payments to doctors and hospitals if state lawmakers don't pass a budget by the end of the month. The full article can be read in the Riverside Press Enterprise.
Online monitoring by a pharmacist significantly reduced the level of hypertension in patients with uncontrolled blood pressure, according to a study published in Journal of the American Medical Association (JAMA). Researchers at the Seattle Group Health Cooperative found that 56% of adults with uncontrolled hypertension lowered their blood pressure to below 140/90 mm Hg after a year of online interventions from a clinical pharmacist. Typically only about a third of patients with high blood pressure achieve adequate control. You can read the article in The Seattle Times (Free Registration Required), and view the JAMA Study here.
This week was to be the beginning of a 10.6% cut to Medicare serving doctors. However, the House voted to block those cuts. You can read more about this latest development in the New York Times and/or the Eureka Times Standard.
Governor Schwarzenegger issued a news release today regarding fireworks and the current fire danger in California. To read the release, click here.
Question of the Week
Lynn,
A couple questions: Does Medi-Cal still allow pharmacies to charge a co-pay? Is there a limit to the amount? Is it in addition to the allowed amount that Medi-Cal pays, or does it reduce the amount paid by the state?
Thanks.
Tom Buford, PharmD
Owner, Leoni Pharmacy
Answer
Dear Tom,
The following answer comes from John Cronin:
“Medi-Cal does authorize co-payments of $1 per prescription. The co-payment is in addition to any amount paid by the Medi-Cal Program. However, co-payments are generally uncollected for a variety of reasons, not the least of which is that pharmacies cannot deny care to beneficiaries who are unable to pay. In addition, the co-payments do not apply to any beneficiary under 18, over 65, or pregnant. There are additional exemptions for some beneficiaries who reside in facilities. If the pharmacy can collect the co-payments from Medi-Cal patients, the additional revenue will offset only a minimal portion of the loss from the 10% cuts. The reality is that reimbursements for many frequently prescribed single source branded drugs will be $20, $30 or more below the typical pharmacy’s acquisition cost.”
Thank you for the question.