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ASHP Renews Call for Pharmacist Reimbursement

Nancy Tarleton Landis

Plans announced recently by the Health Care Financing Administration (HCFA) to change the reimbursement structure for Medicare-covered prescriptions underscore the need to compensate pharmacists for their patient-care role, according to ASHP.

Under the current system, Medicare reimburses health care practitioners, including pharmacists, at 95 percent of the drug's average wholesale price (AWP). According to state and federal investigators, the AWP is substantially higher than what the health care practitioner actually pays for the drug products. The difference is used to cover the cost of storing, handling, and administering the medication. 

Beginning in October, Medicare claims processors will use lower prices compiled from drug wholesalers' catalogs. The new prices are already being used by state Medicaid programs. Since no separate reimbursement methodology is in place to cover dispensing costs, ASHP fears that this cut will dramatically impact patient care. 

"The failure to include handling and administration costs under the current Medicare reimbursement structure ignores a vital element of the medication-use process," said ASHP Executive Vice President Henri R. Manasse, Jr., Ph.D., Sc.D. "We intend to continue educating legislators and other policymakers about the vital role pharmacists play in providing drug therapy management for patients." 

The Society supports a proposal sponsored by Rep. Nancy Johnson (R-Conn.) that calls for the Government Accounting Office to study, before implementation of a new reimbursement structure, the likely consequences those changes will have on patient care.