24 States Now Life with NABP PMP InterConnect
The National Association of Boards of Pharmacy's "Prescription Monitoring Program" (PMP) InterConnect participation continues to grow with Idaho and West Virginia's prescription monitoring programs now live as of February 2104.
Authorized users in 24 states are sharing data through NABP InterConnect, which enables the secure transfer of PMP data among participating states: Arizona, Arkansas, Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Nevada, New Mexico, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Virginia, West Virginia and Wisconsin.
Two additional states have signed memorandums of understanding (MOU) to participate. Four states have MOUs under review.
Approximately 30 states will either be connected to or working toward a connection to NABP InerConnect in 2014. Since launching, the NABP Inter-Connect has processed more than 5.5 million requests, with an average wait time of 7.5 seconds for a consolidated multistate report.
The most up-to-date information about state PMP participation is available in the NABP InterConnect map, located in the Programs section of the NABP web site at: www.nabp.net
Guidance on Part D Coverage of Hospice Drugs:
CMS has issued a final memo providing guidance for Part D sponsors and hospices as it relates to payment for drugs for hospice beneficiaries in 2014. The effective date of this policy clarification will be May 1, 2014 and will be applied prospectively. When a beneficiary (or authorized representative) has elected the hospice benefit, the hospice is responsible for covering all drugs or biologicals for the palliation and management of the terminal and related conditions. Drugs and biologics covered under the Medicare Part A per-diem payment to a hospice program, therefore, are excluded from coverage under Part D.
For prescription drugs to be covered under Part D when the enrollee has elected hospice, the drug must be for treatment of a condition that is completely unrelated to the terminal illness or related conditions. CMS expects drugs covered under Part D for hospice beneficiaries will be unusual and exceptional circumstances. Therefore, the sponsor should place beneficiary-level prior authorization (PA) requirements on all drugs for beneficiaries who have elected hospice to determine whether the drugs are coverable under Part D. CMS expects Part D sponsors should implement processes to handle payment resolution directly with hospice providers and beneficiaries without requiring the pharmacy reverse and rebill the original claim in the retail setting. However, whenever the network pharmacy involved is also the hospice pharmacy, as is often the case with long-term care pharmacies, reverse and rebill may be the most appropriate approach.
Update on Federal Provider Status Efforts
On March 11, 2014, HR 4190 was introduced in the US House of Representatives to recognize pharmacists as providers under Medicare Part B.
The current legislation, introduced by Representatives Brett Guthrie (R-KY), G.K. Butterfield (D-NC), and Todd Young (R-IN), will enable patient access to, and reimbursement for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Pharmacists, as the most accessible health care professionals, are uniquely positioned to provide patients in medically underserved communities access to health care services that are already within their scope of practice. By providing for a payment mechanism under Medicare Part B, the bill will allow pharmacists to help fill the gaps in care that have been created by shortages of health care professionals and increases in the number of Americans who are now eligible to gain health insurance under the Patient Protection and Affordable Care Act.
Although provider status has been a profession-wide goal for many years, activity began picking up in early 2013 and have come to a head with the formation of the Patient Access to Pharmacists’ Care Coalition (PAPCC). The coalition currently represents over 20 organizations and is continuing to grow. Members include organizations representing patients, pharmacists, pharmacies, and other interested stakeholders.
This coalition is focused on developing and helping to enact a federal policy proposal that will enable patient access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Their primary goal is to expand medically underserved patients’ access to pharmacist services consistent with state scope of practice law.
Getting HR 4190 passed may be a long term effort (possibly even multiple years) that will require grassroots advocacy from all pharmacists. Get ready for action alerts asking you to send letters and emails and make phone calls to your legislators! WV Pharmacists Association will continue to work with our national partners to make sure that you are kept up to date on the progress of HR 4190 and PAPCC. To read the press release from PAPCC, click here: http://bit.ly/1ix4RQQ.