Pharmacy groups urge changes to long-term care mandate in health-reform bill; offer alternatives

ALEXANDRIA, Va. Two independent community pharmacy advocates are urging Congress to consider more practical alternatives to legislation that would effectively mandate the purchase of expensive, unproven equipment intended to reduce the amount of wasted medication in long-term care settings.

The National Community Pharmacists Association and GeriMed, of Louisville, Ky., representing independent long-term care pharmacies, wrote a letter to Senate Finance Committee chairman Max Baucus, D-Mont., and House Energy and Commerce Committee chairman Henry Waxman, D-Calif., regarding provisions in both the House and Senate-passed versions of healthcare reform. Under the current proposed language, pharmacies participating in the Medicare Part D drug benefit and serving long-term care facilities would have to utilize specific dispensing techniques, such as weekly, daily, or automated dose dispensing. For most independent pharmacies, that would require the purchase of a costly technology system along with major changes to the work flow of the pharmacy, the organizations said in a release.

“Reducing waste and promoting appropriate disposal of unused medications is very important,” the groups wrote. “However, small pharmacies may have more difficulty accessing or paying for this new technology, which has not yet been incorporated into the daily practices of independent pharmacies.”

Further, NCPA and GeriMed note that the new technology “has not even been thoroughly pilot-tested to see if it decreases waste of medications.”

To meet Congress’ goal of reducing the volume of unused medicine, while avoiding the problems noted above, NCPA and GeriMed offered lawmakers several options:

• Ease the equipment costs and other burdens of a shift to shorter dispensing cycles, such as through more frequent, full dispensing fees, tax credits, or direct financial incentives;
• Require prompt payment from Part D plans to pharmacies that serve long-term care facilities;
• Require the U.S. Secretary of Health and Human Services to both consult with pharmacies and other stakeholders in developing standards and techniques to reduce waste as well as engage in a rulemaking process before the imposition of any uniform standards for these types of dispensing techniques;
• Test the new dispensing techniques to ensure their practicality for pharmacies and effectiveness at decreasing waste;
• Investigate other alternatives to reduce waste, such as credit and return of unused drugs and post-consumption billing; and
• Identify and reduce pharmaceutical waste in Part D mail order dispensing. One study estimates that mandatory mail order programs create 3.3 times more prescription drug waste than programs that allow the patient to use their local community pharmacy. Visit www.ncpanet.org/pdf/leg/uamsmailorderrprt.pdf to read the full study: Effect of Mail-Order Pharmacy Incentives on Prescription Plan Costs.