Law designed to prevent Medicaid fraud postponed AND Pharmacy Groups Seek Delay on Medicaid Rx Pad Rule

[CAL/AAEM News Service]

Law designed to prevent Medicaid fraud postponed

Source: Times West Virginian ( http://www.timeswv.com )
Date: October 6, 2007

FAIRMONT — A law that would have mandated that the prescriptions of Medicaid patients be
written on tamper-resistant paper, or blanks, as of last Monday has been postponed for
six months.

Some pharmacists did not object to the law — designed to prevent Medicaid fraud — so much
as to the fact that they feared physicians and patients had not been given enough time to
prepare for the new rules.

“If it’s not on a tamper-resistant prescription blank, then we can’t fill it. Then we
have to call the doctor to verbally get the prescription or we have to turn them away,”
said Jonathan Rider, owner of Rider Pharmacy in Fairmont, before both the U.S. Senate and
House of Representatives passed legislation late last week to postpone enactment of the
new rules.

“It’s a big mess and another burden on the patients.”

When enacted, the law only will apply to written prescriptions and not electronic or
phoned-in orders.

“The hole in that is that in many states, including West Virginia, Schedule II narcotics
must be in writing,” said Dave Potters, the executive director and general counsel for
the West Virginia Board of Pharmacy. “Those are the most likely divertible
prescriptions.”

Schedule II drugs include morphine, hydrocodone and oxycodone.

The law to require tamper-resistant pads was tacked on to an act passed last spring
called the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability
Appropriations Act of 2007.

Tamper-resistant prescription pads contain security features specifically designed to
prevent alterations and forgeries, although some health officials also worried that what
exactly constitutes an appropriately tamper-resistant prescription pad is unclear.

“It could be better defined,” said John Norton, public relations manager for the National
Community Pharmacists Association. “We’re hoping for a little more clarity. We also would
like to work on bringing the doctors into the process to make sure everything is in
compliance. Right now, the onus is on pharmacies.”

Pharmacists and other health officials were not made aware of the specific changes until
late in the summer, and they feared that doctors would be unprepared for the change by
Oct. 1. A spokesman for the American Medical Association noted that most doctors
currently do not stock the tamper-resistant blanks.

 “They didn’t give us much time to prepare,” said Peggy King, director for the West
Virginia Bureau for Medicaid Services, which administers the program to about 320,000
Medicaid recipients in the state.
The national Centers for Medicare and Medicaid Services, or CMS, “had promised to give us
a guidance, but we didn’t get it until late August. We only had about a little over 30
days to prepare. We felt like it was going to be an imposition. We were relieved when
there was a delay, even at the last minute.”

Congress passed legislation last week to postpone enactment of the legislation until
March 31, 2008.

“This six-month delay will help doctors and pharmacies establish an action plan and allow
for a smooth transition to those Medicaid patients that would be affected by the new CMS
law,” Rider said.

Others in the health industry supported the delay as well.

“We don’t oppose the legislation at all,” said Chrissy Shott, vice president of media
relations for the National Association of Chain Drug Stores. “We support curbing health
care fraud and abuse.”

King did not have any statistics on the level of prescription fraud that does take place
among Medicaid, and a CMS representative did not return phone calls.

Terri Vilain, owner of White Hall Pharmacy, does not expect the change to be problematic
when they do go into effect.

“It’s not really going to be cumbersome,” she said. “It just changes the prescription
blanks, so once they get the new blanks and write prescriptions on those blanks,
everything should run smoothly.”

E-mail Mary Wade Burnside at mwburnside at timeswv.com.

_______________________________________________________________


Pharmacy Groups Seek Delay on Medicaid Rx Pad Rule

Source: The California HealthCare Foundation ( http://www.chcf.org )
Date: September 26, 2007


Pharmacy groups are lobbying Congress to ask for a delay of a rule scheduled to take
effect Oct. 1 that will require prescriptions for Medicaid beneficiaries to be written on
tamper-resistant pads, claiming the rule would force them to deny treatment to Medicaid
patients, CongressDaily reports. 

The National Association of Chain Drug Stores, the National Community Pharmacists
Association and the Food Marketing Institute said they agreed with the rule but cited a
lack of availability of tamper-proof pads (Edney, CongressDaily, 9/25). 

The provision was included in a spending measure for the Iraq war. The law was designed
to make it more difficult for patients to obtain controlled substances through forged
prescriptions and to save the government money (California Healthline, 7/20). 

Bob Loeffler, CEO of H-E-B grocery stores and a member of the NACDS board of directors,
said, "It's a great idea, but we have a whole system that is chock-full of
nontamper-proof pads right now." He said pharmacists would have to either turn patients
away or fill Medicaid prescriptions written on nontamper-proof pads and forgo
reimbursement. CMS has explained that emergency prescriptions written on nontamper-proof
pads would be accepted. 

Rep. Charlie Wilson (D-Ohio) and Sens. Sherrod Brown (D-Ohio) and George Voinovich
(R-Ohio) have introduced legislation that would delay the requirement for six months. The
lawmakers plan to attach their bills to a continuing resolution, which would continue
government operations while final budget negotiations for the upcoming fiscal year take
place, or to the State Children's Health Insurance Program legislation to be voted on
later this week (CongressDaily, 9/25).

Readers are invited to send feedback to: chl at chcf.org

Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/



       
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