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Executive Summary

HCFA ADMINISTRATOR ROPER SEES "TWO SIDES" TO PHYSICIAN DISPENSING and issues involving physician-owned home I.V. administration businesses and clinical laboratories. Addressing a Sept. 16-19 meeting of the National Council of State Pharmaceutical Association Executives, hosted by the American Pharmaceutical Association in Washington, D.C., Roper said he remains interested in such issues but does not "have a fully framed position on various financial arrangements" by doctors. "I have two sides to this concern," the Health Care Financing Administration head explained in response to a question by Georgia Pharmaceutical Association Executive VP Larry Braden. "On one side, I can see that there are real conflicts of interest" that can be "harmful to our getting best value for the dollar." "On the other hand," Roper continued, "we are seeking a more competitive health care system, and as competition happens, more and more complicated arrangements are going to be put in place between the various parts of the health care system. What looks very much to one person like a kickback will look to another like a legitimate business relationship." Connecticut Pharmaceutical Association Executive Director Daniel Leone asked whether a physician's override of generic substitution under his state's law, which requires that the prescriber handwrite "no substitution" on the prescription form, satisfies federal Medicaid requirements that the physician write "brand medically necessary." Responding that he would have to consult the federal regulation, Roper maintained that such confusion was the result of policies that dictate rather than let marketplace forces operate. Roper said he supports the idea of prepaid managed care claims "as opposed to further regulating the service system" because otherwise "layer upon layer of bureaucratic detail is inevitable." Roper explained: "The better way is through prepaid managed health care plans . . . so that we can delegate, states can delegate substantial authority, and we don't have to get involved in detailed language" required on an override. Senate Majority Leader Dole (R-Kan.) told the council that long-term health care legislation will be a priority in the next Congress. "I think we had some indication this Congress in the efforts by [Rep.] Claude Pepper [D-Fla.] in the House; he didn't win, but he got a lot of votes for a very, very expensive program." Dole said such a bill "is going to be right on the front burner" because "there is a constituency there, and there is a need."

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