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April Legislative Update

HB 149 : Optometry Legislation Now in Effect

New legislation is now in effect that somewhat expands optometrists' ability to prescribe.  The primary target of the legislation was to allow optometrists to utilize certain Schedule III medications, but rules must be written in the next few months, and the DEA must issue licenses to those who will be prescribing those medications.  Generally, the optometrist may only prescribe drugs that are within the scope of practice of the profession, which is the visual system.  Specifically, the expanded drugs include the use of epinephrine in emergencies, glucose testing, and use of oral antiinfectives, allergy medications, glaucoma medications, noncontrolled analgesics, and oral nonsteroidal anti-inflammatory meds.  The notable exception to the oral steroid mandate is that they may use Medrol dose packs (methylprednisolone), used only for allergy, only for a patient over age 18, for one episode, and only in unit-of-use packaging.  We will get more information to you regarding the Schedule III medication dispensing toward the end of the summer, when we expect rules to appear.

AMP Cuts Delayed

The Bush Administration has decided not to appeal the December federal court decision granting an injunction that blocked Medicaid generic drug reimbursement cuts scheduled to take effect January 31, 2008.  The government had until February 19 to appeal.

The original case, to overturn the rule issued by the Centers for Medicare and Medicaid Services (CMS) that uses Average Manufacturer Prices (AMP) as the new basis for reimbursement brought by NCPA (National Community Pharmacists Association) and the National Association of Chain Drug Stores (NACDS) last year, now proceeds on its merits. Even according to CMS, community pharmacies would lose $5.5 million a day under the rule as written.

NCPA and NACDS now are waiting for CMS to produce the administrative record of how it fashioned the rule it issued July 17, 2007. That record is due March 31, although requests for an extension are possible.  As a practical matter, it seems that any AMP rule, new or old, is months away, if not into next year.

At the same time, there are only so many changes that CMS can make to the rule if ordered by the court to rewrite it. NCPA will continue to use the delay to convince Congress of the need for structural improvements in the Medicaid reimbursement system that will not handicap community pharmacies by paying them substantially below their acquisition costs for generic drugs.

April 1 Tamper-Resistant Pad Deadline

The new federal tamper-resistant pad requirement went into effect on April 1. Independent pharmacies are at risk of losing Medicaid reimbursement if they fill prescriptions that do not comply. To be considered tamper-resistant as of April 1, a Medicaid prescription must contain at least one of the following characteristics:

1.  designed to prevent unauthorized copying of a completed or blank prescription form;

2.  designed to prevent the erasure or modification of information written on the prescription by the prescriber; or

3.  designed to prevent the use of counterfeit prescription forms.

By October 1, 2008, the State of Ohio will require all three characteristics on prescription pads in order for them to be considered tamper-resistant.

These requirements do not apply to:

1. e-prescriptions transmitted to the pharmacy;

2. prescriptions faxed to the pharmacy;

3. prescriptions communicated to the pharmacy by telephone by a prescriber;

4. prescriptions for which payment will be made by a Medicaid managed care entity;

5. long-term care prescriptions.

If a patient comes into your pharmacy with a prescription that does not comply with the tamper-resistant rule, the pharmacy may provide an emergency fill of the drug. However, the pharmacy must get a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled.

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