By Elise Viebeck - 05/05/12 04:30 PM EDT
Community pharmacists are pushing back against Grover Norquist for criticizing a piece of their legislative agenda as they prepare to launch a major lobbying effort on Capitol Hill.
The intensive three-day push, to begin Monday, comes in the wake of the recent merger of Medco and Express Scripts — two major pharmacy benefit management companies (PBMs) that local drugstores say abuse their oversight capacity with frivolous audits.
In a letter, the group denied recent claims by Norquist that the measure would "incentivize" Medicare fraud by limiting PBMs' recourse against pharmacies that might bill false prescription charges to the taxpayer.
"Billing for 2,000 pills while only dispensing 20 pills would indeed fall under the category of fraud, waste or abuse. Nothing in H.R. 1971 would prohibit audit recovery under that scenario," NCPA senior vice president John Coster wrote to Norquist.
"However, if the pharmacy can prove … that the billing of 2,000 was a simple keystroke error, then the PBM should not be permitted to make that recovery," Coster said.
He added that pharmacies "see PBMs recover monies … in these very situations where there is no evidence" of fraud.
Norquist is the founder and head of Americans for Tax Reform (ATR), known for promoting its "Taxpayer Protection Pledge" among conservatives in Congress. ATR did not immediately respond to requests for comment.
A spokesman for a major PBM group, meanwhile, said H.R. 1971 "only helps the drugstore lobby" and undermines the ability of companies that use PBMs "to root out wasteful spending on prescription drugs."
"This is a fight between the drugstore lobby and employers," said Charles Cote with the Pharmaceutical Care Management Association (PCMA).
The group employed another line of attack in a recent print advertisement.
"The drugstore lobby wants new laws to stop seniors from choosing Medicare plans with more affordable pharmacy networks. Why? More seniors are choosing those plans … That's a good thing," the ad reads.
H.R. 1971, the Pharmacy Competition and Consumer Choice Act, is one of three bills local pharmacists will push during more than 350 meetings with members of Congress and their staffs next week, according to a release from the group.
The other two bills would set standards for PBM audits of local pharmacies (H.R. 4215) and exempt pharmacies from certain anti-trust laws (H.R. 1946).
Two out of three are sponsored by Rep. Cathy McMorris Rodgers (Wash.), the House's highest ranking Republican woman.
Medicaid chief Cindy Mann, House Ways and Means Committee Chairman Rep. Dave Camp (R-Mich.) and several other lawmakers involved with healthcare issues will speak to the NCPA conference on Tuesday.