Assuring Medicare's seniors access to essential medical equipment

The uncertainty surrounding legislation to shape the future of health care in this country has imperiled an important provision that would benefit many seniors today.  Namely, a bipartisan proposal to exempt community pharmacists from a costly, time-consuming and redundant Medicare regulation that needlessly restricts patients' access to diabetes testing supplies and other essential health care products.  However, there's an easy solution within reach this month.

Congressional support for pharmacists on this issue is strong and bipartisan - and the National Community Pharmacists Association (NCPA) deeply appreciates it.  Lawmakers recognize that:

• Medicare Part B's Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation requirements are costly and self-defeating when it comes to community pharmacies. Upfront compliance costs can run $7,000, in addition to substantial annual costs, and the process must be repeated every three years.
• The requirements are unnecessary for pharmacists, who are already state-licensed health care providers and who have not been associated with the fraudulent billing targeted by Medicare.
• 17 other health care providers have already been exempted.
• Diabetes testing supplies, canes and other DMEPOS make up such a small portion of a pharmacy's business, that many find the headaches and costs of accreditation prohibitive and, thus, can no longer offer the products. That creates access concerns for seniors, many of whom have relied on their community pharmacy for years and live in rural or other areas served by few, if any, accredited local vendors. Community pharmacists have also been a key source of advice to ensure these products are used correctly.

The past 12 months have been filled with plenty of constructive legislative activity in this area:

• Feb. 25 - bipartisan House pharmacy exemption bill introduced by Representatives Anthony Weiner (D-NY), Marion Berry (D-AR) and Jerry Moran (R-KS)
• March 3 - companion, bipartisan legislation introduced in the Senate by Senators Sam Brownback (R-KS), Pat Roberts (R-KS) and Jon Tester (D-MT)
• Oct. 13 - President Obama signs into law bipartisan legislation, authored by Representatives Zach Space (D-OH), Lee Terry (R-NE), Senators Max Baucus (D-MT) and Charles Grassley (R-IA), delaying Medicare's accreditation deadline for pharmacy 90 days to Jan. 1, 2010
• Nov. 7 - House passes health care reform bill including DMEPOS fix
• Dec. 24 - Senate passes health care reform bill with DMEPOS pharmacy exemption

But, unfortunately for patients and pharmacists, there's still no permanent solution.

In deference to the will of Congress, Medicare has held off enforcing the accreditation requirement on pharmacies this year. Recognizing the sense of urgency, on Jan. 26 Senate Finance Chairman Baucus and Ranking Member Grassley sent a letter to HHS Secretary Kathleen Sebelius strongly reinforcing Congress' support for pharmacies on this issue.

Unfortunately, the recent uncertainty surrounding health care reform legislation is changing Medicare's outlook. Program officials told NCPA that on Feb. 12 they would begin sending notices revoking the DMEPOS billing rights of unaccredited pharmacies.  NCPA estimates that about a third of the 20,000+ independent pharmacies selling DMEPOS are not presently accredited.

Many of these pharmacies are in underserved rural or urban areas, giving patients few alternatives to meet their medical needs. Even those pharmacists who completed the accreditation process face re-accreditation two years from now. With pharmacy reimbursement on a downward spiral, there's no guarantee that these pharmacies will all be in a position to absorb those time and financial costs again.

President Obama's recent budget proposal included a significant boost for anti-fraud efforts in Medicare. Certainly, reasonable and aggressive efforts should be taken to ensure taxpayer dollars are spent properly. But, in the case of DEMPOS, pharmacists have been unfairly lumped in with fraudsters.

We urge lawmakers to preserve seniors' access to essential medical supplies and enact this revenue-neutral legislation this month.