MEDICATION USE IN RURAL AMERICA ASSOCIATION UPDATES National Community Pharmacists Association Tina Schlecht, PharmD, MBA Director, Pharmacy Affairs

Patient Protection and Affordable Care Act Medicaid Generic Drug Pharmacy Reimbursement (AMP Fix)  CMS to set FUL for generic reimbursement at “no less than 175% of average weighted AMP.”  Expands Medicaid coverage in 2014 to individuals up to 133% of Federal poverty level Pharmacy Benefit Manager (PBM) Transparency in Health Exchanges  Requires PBMs to confidentially disclose certain financial information to HHS for plans in new health insurance exchanges and Medicare Part D plans. Health exchanges to begin in 2014 Health Care Reform Impact on Community Pharmacy

Pharmacies Exempted from Medicare DME Accreditation Requirement  Pharmacy requirements for exemption: Total Medicare DME billings are 5% or less of total pharmacy sales Has not had adverse fraud or abuse determination against it in the last 5 years Must submit an attestation that its total Medicare DMEPOS billings are and continue to be less than a rolling 3 yr average of 5% of total pharmacy sales Random sample of pharmacies will submit documentation, when requested, to HHS Secretary that would allow Secretary to verify information Health Care Reform Impact on Community Pharmacy

Pharmacist-Delivered Medication Therapy Management Services  Envisions expanded role for pharmacists in new health care models: accountable care organizations, medical homes, transitions of care teams, medication reconciliation activities  Includes grant program to examine new and innovative methods of providing MTM Health Care Reform Impact on Community Pharmacy

Medicare Part D “Donut Hole” Closure  Donut hole to close by 2020  2010: beneficiaries who hit donut hole receive $250 rebate  2011: beneficiaries automatically receive 50% discount on negotiated price of certain medications covered under Part D and plan formularies  Discount increases to 75% by 2020  Beginning in 2020: 25% copay applies until beneficiary reaches Medicare catastrophic coverage Health Care Reform Impact on Community Pharmacy

New Requirements for Long Term Care Pharmacies  Beginning 2012, Medicare Part D and MA-PD plans must begin utilization management techniques such as daily, weekly, or automated dose dispensing Small Business Provisions  Businesses with 50 or fewer employees that do not provide health care coverage will not be penalized  Small business tax credits to encourage small employers to purchase insurance for employees Health Care Reform Impact on Community Pharmacy

340 B Provisions  Expands number of entities eligible to obtain pharmaceutical discounts  Entities to provide discounted prescription medications to uninsured patients Health Care Reform Impact on Community Pharmacy

PBM Audit Reform and Transparency Act of 2010  Expands new PBM transparency requirements in the health care reform bill to all plans, both public and private DME Accreditation Exemption and Competitive Bidding  Would exclude diabetic supplies provided by small pharmacies (< $7 million in annual sales) from DME competitive bidding LTC Prompt Pay After Reform Current Policy Hot Topics