CMS Final Rule Inadvertently Negates Prescriptive Authority for Part D

By: Anonymous on 10:24:00 AM

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On January 10, 2014, proposed rules for "Contract Year 2015 Policy & Technical Changes to Medicare Advantage and the Medicare Prescription Drug Benefit Programs" was published in the Federal Register.   Interestingly, it was only recently that I first caught wind of banter regarding the language within these rules and how it would negatively affect the ability for pharmacists with prescriptive authority to practice.  More importantly, the rule changes may jeopardize patient care and patient safety for some Medicare Part D beneficiaries.

As we all know, the vast majority of states have some form of collaborative practice agreement with specific or limited prescriptive authority.  New Mexico and North Carolina have had pharmacists with prescriptive authority practicing for more than a decade.  In general, pharmacists with prescriptive authority are not only licensed but typically have advanced experience or credentials and practice under their own NPI and DEA registrations.  However no pharmacist is recognized as a Medicare Part B provider.

The CMS Final Rule, noted above, called for enrollment requirements for prescribers by June 1, 2015, now extended to December 1, 2015, in section §423.120(c)(5) and (6) to ensure that all Part D prescriptions be issued by Part A/B providers.

In a time when there is a significant shortage of primary care providers and a prevalence of healthcare inefficiencies and costly expenditures, we cannot afford to implement rules and regulations which stymie progress and impede access to affordable care.

 In addition, this is all too surreal that a rule like this would come about in a time when pharmacists, nationwide, have been addressing provider status and pushing the advanced role that pharmacists should have in patient care.  Just this past fall prescriptive authority from the perspective of public safety and efficiency of care was debated within the NABP District II business meeting.  Now is the time for our overall healthcare system and society to be turning to pharmacists as a solution to help with the healthcare crisis.

I think this rule for prescribing hasn't been on a lot of people's radar, including mine, because it is one item among a mass of others, within a final rule related to Part D, published annually since 2006.  It takes a village to monitor all the proposed rules and regulations for any potential impact to our profession.  I personally send a shout out of thanks to the men and women who work within the policy and advocacy divisions for all our national organizations.

According to the discussion held at the AACP meeting in Austin, TX this past week, the good thing within this conundrum, is that CMS understands the important role that pharmacists have in patient care, and they are willing to consider an amendment to the rule.  CMS needs to hear from us.

What can you do?  What should you do?  It's simple, please write CMS and explain how this rule will negatively impact patient care.  Address your correspondence to

Amy Larrick 

Acting Director, Medicare Drug Benefit and C and D Data Group 

Centers for Medicare & Medicaid Services 

Amy.Larrick@cms.hhs.gov 

and thank you for advocating for our profession and our patients.