From: HME Business

NCPA survey confirms that cuts from bid program will cause a mass exodus by community pharmacies.

By David Kopf

Eighty-four percent of community pharmacists surveyed in a report commissioned by the National Community Pharmacists Association (NCPA) said they would likely drop out of the Medicare diabetes program if forced to take reduced payments or competitively bid.

The survey of 800-plus community pharmacists, conducted over September and October 2011, was commissioned by the NCPA after CMS indicated that by 2016 providers of diabetic supplies (including testing strips, monitors, lancets, glucose control solutions) will either have to accept prices established under the mail order competitive bidding process or competitively bid in order to continue participating in the Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) program.

The price cuts are significant. In July 2011, the average retail single payment amount for diabetes testing supplies was $37.67, whereas the Round 1 Competitive Bidding Program single payment amount for was January 2011 was $14.62.

The survey highlighted various negative consequences for community pharmacies’ patients and their businesses if diabetes testing supplies under Medicare Part B are subjected to competitive bidding prices. Some additional highlights:

  • Eighty-one percent reported that their average Medicare diabetes patient visits their independent community pharmacy 2 or more times per month for counseling and/or diabetes testing supplies.
  • If their patients were forced to obtain diabetes supplies by other means, 84 percent of pharmacists said their patients would suffer a significant impact.
  • The overwhelming majority (81 percent) of independent community pharmacies regularly deliver diabetes testing supplies to patients (often free of charge) with 28 percent making 30 or more deliveries per month.
  • Without that home delivery and counseling from a community pharmacist, 65 percent of pharmacists predicted a significant impact on these patients, many of whom are homebound.

“Like many independents, we really only participate because of the patients, not because of profit,” one pharmacist surveyed noted. “We get most new patients because they are tired of the waste from mail-order.”

“Due to my patient’s disabilities, they need not only delivery, but consultation in order to achieve compliance,” another surveyed pharmacists added.

“The message from our survey is clear: applying competitive bidding prices for diabetes testing supplies to independent community pharmacies is financially unsustainable for these pharmacies and will hurt seniors,” said NCPA Executive Vice President and CEO B. Douglas Hoey, RPh, MBA.

“Community pharmacists are indispensable to helping combat diabetes, whether it is the counseling they offer, the medications they dispense, the lifestyle modification classes they provide, or the testing supplies they carry,” Hoey added. “But that dynamic will be harmed if these small business pharmacies are forced to walk away from a pricing structure that only a large warehouse can make work. Such a mass exodus of community pharmacies from Medicare Part B would diminish seniors’ access and the health complications that could ensue will only increase overall health costs.” 

To fight the inclusion of diabetic testing supplies in competitive bidding, the NCPA has been supporting H.R. 1936, The Medicare Access to Diabetes Supplies Act, introduced by U.S. Representatives Aaron Schock (R-Ill.) and Peter Welch (D-Vt). The bill permanently exempts diabetes testing supplies furnished by independent community pharmacies (defined as 10 or fewer privately owned stores) from competitive bidding and also permits these pharmacies to continue providing home delivery without being subject to competitive bidding costs.