Pink Sheet is part of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC’s registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

This copy is for your personal, non-commercial use. For high-quality copies or electronic reprints for distribution to colleagues or customers, please call +44 (0) 20 3377 3183

Printed By

UsernamePublicRestriction
UsernamePublicRestriction

NARD & NACDS STATE CAMPAIGNS AGAINST REIMBURSEMENT FORMULA CHANGES

Executive Summary

NARD & NACDS STATE CAMPAIGNS AGAINST REIMBURSEMENT FORMULA CHANGES, sought by Health Care Financing Administration (HCFA) regional offices, stress states' rights and obligations and nonobligations to state Medicaid directors who reimburse pharmacists under Rx drug programs financed jointly by the state and federal govts. Besides their insistence at the natl. level that HCFA must follow legal procedures for adopting any new reimbursement policies the Natl. Assn. of Retail Druggists (NARD) and Natl. Assn. of Chain Drug Stores (NACDS) are encouraging resistance by the states to what they claim are "illegal" changes in pharmaceutical reimbursement regs. NACDS has written letters to all state Medicaid directors, while NARD is urging state pharmacy assn. execs -- as well as NARD leaders -- to alert state Medicaid officials "that HCFA's actions are unlawful." NARD's Aug. 16 Washington Bulletin includes a two-page summary of legal issues involved in HCFA's threatened cutoff of funding to states that do not accept "mandated reimbursement changes." NARD asked its Bulletin recipients to tell Medicaid officials that they "expect that the state will assert its rights and protect the state Medicaid program." Ten potential violations of laws, regs or govt. policy are cited by NARD in the document. The states themselves could be involved in two violations because of any reimbursement changes mandated by HCFA without procedural safeguards, according to NARD's legal summary. The states, NARD cautions, could be in a position of violating "state Administrative Procedures Act requiring notice and comment for any such change," and a Medicaid reg "requiring public notice of state method and standards for setting payment." NACDS advises in its letters that state Medicaid directors can ignore HCFA "pressuring" to make changes in the Rx drug reimbursement formula. NACDS President Robert Bolger wrote the Medicaid directors: "We wish to advise you that your office is under no obligation to make these changes" representing a shift away from AWP to Actual Acquisition Cost (AAC) as the basis for reimbursement for pharmacies. HCFA must allow for public review and a period for comments from all interested parties if the agency intends to move from AWP to AAC, Bolger admonished. He added: "Since there has been no notice of rulemaking and opportunity for comment, NACDS firmly believes that HCFA is in violation of the Administrative Procedures Act (APA). Finally, we are of the opinion that the regional offices of HCFA have never been empowered with the authority to make changes in regulatory policy through administrative interpretation." HCFA enclosed in the letters a copy of its May 31 testimony on the issue before Rep. Natcher's (D-Ky.) HHS Appropriations Subcmte.

You may also be interested in...



Part D Discount Liability Coming Into Focus: CMS Releases Drug Cost Data

Newly released Medicare Part D data sheds light on the sales hit that branded pharmaceutical manufacturers will face when the coverage gap discount program gets under way in 2011

FDA Skin Infections Guidance Spurs Debate On Endpoint Relevance

FDA appears headed for a showdown with clinicians and the pharmaceutical industry over the proposed new clinical trial endpoints for acute bacterial skin and skin structure infections, the guidance's approach for justifying a non-inferiority margin and proposed changes in the types of patients that should be enrolled in trials

Shire Hopes To Sow Future Deals With $50M Venture Fund

Specialty drug maker Shire has quietly begun scouting deals with a brand-new $50 million venture fund, the latest of several in-house investment arms to launch with their parent company's pipelines, not profits, as the measure of their worth

UsernamePublicRestriction

Register

MT125529

Ask The Analyst

Please Note: You can also Click below Link for Ask the Analyst
Ask The Analyst

Your question has been successfully sent to the email address below and we will get back as soon as possible. my@email.address.

All fields are required.

Please make sure all fields are completed.

Please make sure you have filled out all fields

Please make sure you have filled out all fields

Please enter a valid e-mail address

Please enter a valid Phone Number

Ask your question to our analysts

Cancel