Regulatory & Reimbursement News, In Brief
Executive Summary
Some AHRQ research activities expected to shift to PCORI in White House 2013 budget request. Confusion over non-preferred pharmacy networks in Medicare Part D noted by CMS. Pharmacist organization RxAlly launches with focus on medication adherence.
AHRQ To Scale Back Evidence Synthesis Work
The Agency for Healthcare Research and Quality is planning on scaling back some of the work its Evidence-based Practice Centers do in terms of releasing reports that synthesize evidence on various research topics. According to the White House’s fiscal 2013 budget request, there is a $7 million reduction in appropriated funds to $10 million for patient-centered health research at AHRQ. Lucie Levine, AHRQ’s budget officer, explained that the evidence synthesis work is being scaled back with the expectation that the Patient-Centered Outcomes Research Institute will be doing work in this area. However, AHRQ’s overall budget for patient-centered health research will increase when counting mandated funding from the Patient-Centered Outcomes Research Trust Fund, which also funds the activities of PCORI and is separate from the annual appropriations process. Trust fund dollars are to be allocated for specific activities that do not involve research.
Express Scripts-Walgreens Split Impacting Plan Selection In Part D?
The Centers for Medicare and Medicaid Services will update the Medicare Plan Finder website “as soon as possible” to help provide beneficiaries with drug cost estimates that reflect the selected pharmacy’s status as preferred or non-preferred in a Part D plan’s network, CMS says in a draft version of its annual call letter to plans, released Feb. 17. The agency explains that “with the increase in the number of Part D plans offering cost-sharing differentials between ‘preferred’ and ‘non-preferred’ network pharmacies, we have begun to receive reports of beneficiary confusion over whether preferred cost sharing is available at individual pharmacies.” In future, beneficiaries will be required to select a specific pharmacy when comparing drug costs on Plan Finder.
Although the agency does not mention Walgreen Co. by name, it is likely the big drug chain’s exit from the Express Scripts Holding Co. pharmacy network Jan. 1 is being felt in the Part D program (Also see "Express Scripts Dispute With Walgreens Spotlights PBMs’ Thirst For Deeper Discounts" - Pink Sheet, 9 Jan, 2012.). Express Scripts handles pharmacy benefit management duties for a number of Part D plans. CMS also is proposing that plan sponsors offering preferred and non-preferred cost sharing “clearly designate their pharmacy contracts” to “improve transparency around these arrangements.” The agency additionally seeks comments on preferred Part D pharmacy networks in general and “other ideas on how to make these arrangements more transparent to Medicare beneficiaries.” Comments are due March 2, and the final call letter is scheduled to be released April 2.
RxAlly Launches In Effort To Boost Pharmacist Participation In Health Care Delivery
A new organization, RxAlly, officially launched with the aim of increasing the role that pharmacists play in the delivery of health care, with a focus on improving medication adherence. The network, launched Feb. 22, will work with pharmacists on all scales – from the independent community pharmacy to regional and nationwide chain pharmacies – to provide tools and technologies that enable enhanced interaction between the pharmacist and the patient. RxAlly also will develop standards to measure the performance of these interactions. Finally, the new organization will work with payers to help secure additional reimbursement to pharmacists in recognition of the value that this increased interaction will bring to help reduce the overall cost of health care. RxAlly said at its launch that more than 20,000 pharmacists have joined the network, including those who work at Walgreen Co.