Government Affairs Update - Week Ending December 19, 2009

Health Care Reform: As of Saturday night, it looked like the Senate was on track to pass its version of a health care reform bill right before Christmas. This morning, Senate Majority Leader Reid (D-NV) released the “manager’s amendment”, which made all the changes to the original combined Senate health care bill that he needed to make to be sure he had 60 Democratic votes to stop debate on the bill and move to final passage. Passage of the Senate bill will set up a conference with the House to reconcile the two bills. The stated goal is to have the final bill to the President by the State of the Union address, which is in later January. Read More from NCPA

Oklahoma Collaborative Medication Therapy Management Language- Proposed RULES

OSBP Executive Director John Foust, Dr. Tom Davis and OPhA Executive Director Phil Woodward met this morning with the State Medical Examiners’ office and the Osteopathic Board to discuss the Collaborative Medication Therapy Management draft language to be placed in the Oklahoma Pharmacy Practice Act rules. Discussions to be continued. MTM Draft Language_Rules

HCR Bill information from Senate Majority Reid's office regarding timing

'We will have a cloture vote on the message from the House on the defense conference report at 1 a.m. Friday morning. We would then have a vote on final passage on the bill at 7 a.m. on Saturday morning.
Following passage of the DoD bill, Senator Reid would file cloture on the manager's amendment, substitute amendment and the underlying bill on health care. This would set up the first cloture vote on the manager's amendment on Monday morning at 1 a.m. The second cloture vote on the substitute amendment would be Tuesday at 7 a.m. And, the cloture vote on the underlying bill would be Wednesday at around 1 p.m. We could get an agreement to wrap up and have a final passage vote on the 23rd, however Republicans could continue to not cooperate and force us to have a vote on final passage on Christmas Eve. We then need to deal with the debt limit. If we get consent with the Republicans, we could vote on that before we leave for Christmas. If not, we will have to come back the week between Christmas and New Years to vote on that.'

The 15th day of official Senate debate on the Patient Protection and Affordable Care Act (H.R. 3590) resumes at 10:00 a.m. today.

Few changes to the bill have been made on the Senate floor. Rather, Senate Majority Leader Reid (D-NV) has been working behind-the-scenes on a manager’s amendment that will incorporate the necessary modifications to the current bill to secure the 60 votes required for passage.

As Reid looks to secure 60 votes, agreement on two highly-controversial issues remains elusive - abortion and the public health insurance option. Senator Ben Nelson (D-NE), a pro-life Democrat whose vote is crucial to passing health reform, was unable to pass his anti-abortion amendment. Nelson has previously stated that he would not support a bill that does not contain a strong prohibition on federal funding for abortions. Several senators are working to develop compromise language that will be amenable to both sides of the abortion issue.

As noted last week, a group of liberal and moderate Democrats sent a proposal to the Congressional Budget Office (CBO) for analysis. This proposal would replace the public health insurance option with a national marketplace for individuals to purchase private health insurance plans. This proposal originally included a “Medicare buy-in” provision that would enable certain individuals aged 55-64 to purchase Medicare coverage. However, at the insistence of Senator Joe Lieberman (I-CT), the Medicare provision was dropped from the proposal. Senate Democrats await the results of the CBO analysis, which could come any time this week. The conclusions of the CBO review will be vital to the fate of health care reform in the Senate. More Information from APhA

From NCPA- Update On Medicaid Pharmacy Reimbursement AMP Fix:

We are working with various Senate offices to get signatures on a letter being circulated by Senator Johnson (D-SD) to Senator Reid that asks for a higher Medicaid generic reimbursement rate for independent and small pharmacies. Additionally, the letter asks Majority Leader to ensure that any final bill includes at least the Senate language of “no less than 175%” weighted average AMP in an effort to fend off a compromise number with the House reimbursement, which is at 130% of the weighted average AMP. The need to fight for the Senate language is evident. The Senate's reimbursement level will restore $2.8 billion in Medicaid pharmacy reimbursement, while the House bill will only restore about $1.8 billion.

The House Congressional Community Pharmacy Coalition has circulated a letter among the community pharmacy coalition and the House Rural Health Care Caucus which urges House leadership to accept the Senate AMP fix provision which sets the FUL at no less than 175%, rather than the House provision which sets the multiplier at 130%. We are grateful for the assistance of Reps. Berry, Moran, Weiner, McMorris Rodgers, and Childers who are circulating the letter on behalf of the caucus.

More detail about the various MTM amendments that are being considered by the Senate as part of the health care reform package:

1. Hagan Amendment: Senator Hagan (D-NC) has an amendment that is part of a broader amendment package of cost containment and quality measures offered by several Freshmen Dem Senators. The amendment would codify many of the Part D MTM changes proposed by CMS in its 2010 call letter, which are set to go into effect in January. NCPA is supporting this amendment.

2. Akaka Amendment (3109): Senator Akaka (D-HI) has an amendment that would establish a Part D "chronic care management" program for targeted individuals. This is the proposal that PCMA was floating earlier this year. Its a mail order proposal and we are opposing this. The bill also requires accreditation for pharmacies to participate in this program. All pharmacies are state licensed, and requiring pharmacies to obtain accreditation to dispense prescription medications is unnecessary. We understand consumer groups are being asked to endorse this amendment, so we are encouraging calls today into Senate offices to oppose.

3. Menendez Amendment (3110): Senator Menendez's (D-NJ) amendment would create a performance-based payment program for pharmacies in Medicare Part D. The existing Part D MTM program would remain in effect - however, certain patient groups could be eligible to participate in this new program and any willing Medicare Part D pharmacy would be able to participate. Pharmacies would be paid for closing adherence gaps in medication therapy, and the patients could chose the pharmacy they wanted to provide the service. Payments would be made from the Parts A and B Trust Fund, and this program could help demonstrate that prescription drugs and pharmacy services can have an impact on medical spending. While not perfect, we think its another step in demonstrating pharmacy services impact on medical spending, and moves us to a more performance-based model in Part D and maybe in other commercial payers.
Its not clear that any of these will make it into Senator Reid's managers amendment. Alot will depend on the score and any support or opposition.

Patient Protection and Affordable Care Act (H.R. 3590).

• As of last night, only 7 of the 290 filed amendments have been adopted. A list of those amendments is below; Sonnenschein’s tracking sheet of all amendments is attached.
• The key issues of debate continue to be abortion, the public option, Medicare cuts, and cost-containment.
• A group of ten Democrats have been meeting with Senate Majority Leader Reid (D-NV) to work on a compromise and last night a tentative agreement was reached. The proposal has been sent to CBO for a score. We don’t expect to see the details until the CBO’s score is released but is rumored to replace the current public option proposal with: 1) allowing younger individuals to enroll in Medicare; and 2) allowing individuals to buy into a national health insurance market.
• Yesterday, a group of freshman D Senators introduced a cost-containment amendment that includes an amendment to improve Medicare Part D MTM. The amendment and a section-by-section analysis is attached.
Rumors are that Reid is pushing to finish by Christmas? Frosh Amendment