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ASCP Offers Input on Michigan Medicaid Initiative

If Michigan's ambitious Medicaid Managed Long-Term Care Quality Initiative is to succeed, consultant pharmacists need to be a part of the equation. That's the overriding message of an ASCP comment paper forwarded recently to state officials crafting a HCFA waiver proposal for moving the state's Medicaid long-term care population into managed care.

The ASCP comment paper emphasizes the uniqueness of the frail elderly population and the specialized skills and expertise consultant pharmacists can apply to improve drug therapy and overall treatment outcomes.

"As prescription drugs are the main treatment for most chronic conditions, consultant pharmacists' management of patients' drug regimens will be essential to the success of a long-term care managed care waiver plan," the comment paper notes. "There is much evidence to show that more extensive use of consultant pharmacists produces better patient outcomes."

ASCP's recommendations incorporate many suggestions already put forth by ASCP's Michigan affiliate, the Consultant Pharmacists Society of Michigan, and draw heavily from ASCP's new monograph Pharmacy Services in Managed Care: A Guide for Managed Care Plans.

Specific recommendations include:

• Close involvement by consultant pharmacists in aggressive interdisciplinary case management aimed at providing care in the most appropriate, least restrictive setting
• Close involvement by consultant pharmacists on interdisciplinary care planning committees including other health care professionals, patients, families, and caregivers
• Collaboration by consultant pharmacists and physicians in developing educational programs to foster proper formulary use, as well as ongoing communication through regular forums or committee meetings
• Full use of consultant pharmacist services such as drug regimen review, therapeutic interchange, formulary development and management, patient- and facility-targeted inservice education, and continuous quality improvement programs

Medicaid Managed Care: Take It Slow, Report Urges

States setting up Medicaid managed care programs under federal waivers need to allow more time for program planning and implementation, according to a HCFA-commissioned report examining first-year program experiences in Hawaii, Rhode Island, and Tennessee.

To minimize enrollment problems and provider reimbursement headaches, the report says, states should hire more administrative staff to facilitate program start-up and allocate more resources to set up automated enrollment tracking systems.

In addition, more resources should be earmarked for educating low-income enrollees about managed care basics, provider choices, and appropriate use of gatekeeper providers and emergency room services, the report advises.

Enrollees in the three programs are generally satisfied with the care they receive; chronically ill and disabled patients have registered the most complaints. The report also notes that state efforts to monitor quality of care received by plan enrollees are hindered by a lack of current provider encounter data.

The report is available from Mathematica Policy Research Inc. at 609-275-2334.

North and South Dakota Consider Drug Pricing Bills

Drug pricing bills working their way through the South Dakota and North Dakota legislatures would require manufacturers to offer the same pricing terms and conditions to all buyers, regardless of class of trade.

Similar in content, the bills (North Dakota, S.B.2308; South Dakota, H.B.1008, S.B.6) would allow volume discounts only if such arrangements are: justified by economies or efficiencies resulting from volume purchases; represent reasonable value to the manufacturer for actual marketing functions; meet in good faith the equally low prices or terms of a competitor; are provided for prompt delivery; and are provided for opportunities available to all purchasers or wholesalers on equal terms through market share movement agreements.

In addition to the terms listed above, the South Dakota bills would permit volume discounts based on formulary placement.

1996 Year-End Managed Care Penetration

Data not available for Alaska and Hawaii. Sources: National Resource Corporation; InterStudy, The Competitive Edge Regional Market Analysis

	Less than 25%
	25% - 40%
	Greater than 40%
	Metropolitan area with more than 1 million enrollees

New Mexico Adopts New Pharmacy Regulations

New Mexico officials recently announced adoption of new nursing home drug control standards, as well as a new pharmacy practice regulation requiring pharmacies to maintain records on all retail prescription recipients.

The new drug control standards stipulate that a designated nursing facility staff member may transcribe prescription orders from physicians and transmit them to a pharmacy via telephone or facsimile machine. The rule stipulates that pharmacists must create a hard copy of the phone or fax prescription, and dispensing is limited to 35-day supplies; refills are permitted only upon receipt of a signed physician order.

The new practice regulation stipulates that pharmacists make reasonable efforts to obtain and document a variety of patient information, including name, address, telephone number, date of birth, gender, and medication history. In addition, when processing new prescriptions or refills, either a licensed pharmacist or pharmacy intern must personally offer to discuss with the recipient any matters that might have a bearing on optimizing drug therapy.

Uniform Prescription Law Enacted in New Jersey

New Jersey is the first state to require use of uniform prescription blanks in all drug transactions. Legislation recently signed into law by Gov. Christine Todd Whitman (R) mandates that within six months all prescriptions issued in New Jersey shall be issued on tamper-proof, nonreproducible paper. Prescription blanks will be imprinted with both prescriber and facility license numbers.

Virginia 'Anti-Switch' Bill Killed in Committee

A legislative initiative in Virginia to prohibit incentive-based therapeutic interchange programs-the first initiative of its kind in any state-has been defeated in the state assembly.

Last month, committees of the state's House of Delegates voted to kill the "Virginia Anti-Drug Switching Patient Protection Act," which would have effectively put a halt to drug-switch programs sponsored by insurers and PBMs. Specifically, the act would have made it unlawful for anyone to encourage a prescriber to substitute a therapeutically equivalent but "chemically dissimilar" drug for a prescribed drug for the purpose of obtaining a "rebate, kick-back, or other such renumeration."