Saenz Pharmacy & Medical Equipment (DME) - McAllen, Mission, Edinburg, Penitas

APRx Files Federal Suit Against HHS

to End Humana-Walmart-Preferred Plan



American Pharmacies today filed a federal court suit against the U.S. Department of Health and Human Services to stop it from allowing illegal, anticompetitive preferred pharmacy networks that violate the Medicare Act's mandate for fair competition.


Background

When Congress added the Part D Prescription Drug Benefit to Medicare in 2003, it included the "Any Willing Pharmacy Requirement" to ensure the fair participation of all pharmacy providers: "[a] prescription drug plan shall permit the participation of any pharmacy that meets the terms and conditions under the plan." This statutory provision was intended to ensure fair competition among Rx providers and allow patients to maintain pharmacy relationships and pay network prices without switching pharmacies.


However, CMS issued a "Preferred Pharmacy Rule" allowing Prescription Drug Plans to discriminate among pharmacies in order to steer patients to preferred in-network providers. Although the rule was adopted in 2006, PDPs only recently started creating preferred pharmacy networks. The Humana-Walmart-Preferred Rx Plan that took effect in January is the first such large plan, charging lower co-payments for both generic and brand-name drugs than non-preferred pharmacies in the same network are allowed to charge. Humana's PDP allows Walmart to charge a $2 copay for a 30-day supply of preferred generic drugs, compared to $10 for non-preferred pharmacies. The Walmart co-pay is $6 for 90 days of preferred generics; non-preferred pharmacies must charge $30.

Filing Information

The suit was filed in the Corpus Christi Division of the U.S. District Court's Southern District. It names the U.S. Department of Health and Human Services (HHS), HHS Secretary Kathleen Sebelius, the Centers for Medicare and Medicaid Services (CMS) and CMS Administrator Donald M. Berwick as defendants.


Main Points of the Lawsuit

The lawsuit asserts that CMS' network preferred model violates the Any Willing Pharmacy Requirement by allowing preferential treatment of some in-network pharmacies above others. The lawsuit asks the federal court to declare the Preferred Pharmacy Rule illegal and order it set aside.


What's at Stake?

Medicare patients are often a large percentage of a typical pharmacy's sales, so the Humana-Walmart plan is costing community pharmacies signifi cant revenue and compromising the provider choices of their patients. The plan is a troubling precedent for creating anticompetitive, preferential networks for the benefit of a select few providers.


"CMS is ignoring Congress' statutory imperative to keep a level playing field and protect patient choice," APRx President Mike Gohlke said. "The Preferred Pharmacy Rule illegally stifles competition by giving preferential treatment to one provider with whom we can't effectively compete."
Support the APRx Legal Defense Fund



Our new lawsuit comes less than a year after our landmark suit filed in October 2010 against CVS Caremark. APRx is proud
to be the leader in mounting legal challenges to protect fair competition and patients' right to freely choose their pharmacy provider. These suits are critical - and expensive.



You can support American Pharmacies' newest effort to protect the right of independent pharmacies to fair and equal participation in all Medicare Part D plans.



► Contribute by Cedit Card


► Send a check to:

American Pharmacies Legal Defense Fund

802 North Carancahua St., Suite 1830

Corpus Christi, Texas 78401


Help Us Keep Up the Fight on Your Behalf!

• 
  RGV-IPA Logo

• 
• 

• 
  Members of RGV-IPA, Data Rx, and Hidalgo County officials worked together to create the Valley's first prescription discount card to assist uninsured

• 
  Texas A&M Kingsville P2 pharmacy student intern Mary Olhauser provided free glucose and blood pressure screenings Friday March 4, 2011. The screening

• 

Sugar, Spice, and Everything Diabetes
The American Diabetes Association estimates that 23.6 million children and adults – 7.8% of the United States population – have diabetes. Of these 17.9 million have been diagnosed, while it is predicted that 5.7 million people are living with diabetes undiagnosed.
Diabetes is a group of metabolic disorders characterized by hyperglycemia (high blood sugar) and abnormalities in carbohydrate, fat, and protein metabolism. Hyperglycemia results because the body does not produce enough insulin and/or because the cells in the body do not respond to or use the insulin that is produced. Symptoms of diabetes include polyuria (frequent urination), nocturia (urination at night), polydipsia (increased thirst), polyphagia (increased hunger), and lethargy (tiredness or sluggishness). Type 2 diabetes mellitus (non-insulin dependent) is more prevalent than Type 1 (insulin-dependent) in our community. It is important to understand that type 2 diabetes can progress to type 1 diabetes if left uncontrolled. Uncontrolled diabetes and prolonged hyperglycemia can lead to complications such as changes in vision and eventual blindness, heart disease and stroke, high blood pressure, kidney disease, and disorders of the nervous system. Screening for type 2 diabetes should be performed every 3 years in all adults beginning at the age of 45, but testing should be considered at an earlier age and more frequently in those with risk factors (e.g., family history, obesity, signs of insulin resistance). A diagnosis of diabetes can be made when fasting blood sugar level is above 125 g/dL. After receiving a diagnosis of diabetes mellitus, one might feel like they had been sentenced to a lifetime of medication, appointments, and finger sticks. What many people don’t know is that with the right diet and exercise regimen, Type 2 diabetes mellitus can be reversible. There are also many oral medications, known as anti-diabetic or anti-hyperglycemic drugs, available to reduce blood sugar, stimulate the secretion of insulin, and make cells more sensitive to insulin, but these agents cannot be solely responsible for disease management. Lifestyle modifications and oral anti-diabetic medications work synergistically to control this chronic disease. A proper diet is essential in managing diabetes. An appropriate indicator of proper food is a food’s glycemic index, a measure of how carbohydrates affect blood sugar levels. Low glycemic index foods are preferred over high glycemic index foods because they require a lower insulin demand and may improve long-term blood glucose control. Low glycemic index foods include low-fat yogurt, peanuts, most fruits and vegetables (except potatoes), soy, protein-enriched spaghetti, low-fat milk, chickpeas, wheat, and beans to name a few. Foods to avoid include white bread, watermelon, chips, doughnuts, pretzels, and potatoes, at the very least. Moderate exercise burns fat, allowing cells to utilize glucose more efficiently. Given the associated risk of cardiovascular disease in diabetic patients, lifestyle modifications such as exercise seem grossly beneficial to managing diabetes and reducing complications.
With education, guidance, compliance, and participation doctors and pharmacists can help patients with diabetes and those at risk to understand the disease and how to control it. Compliance, with medications, appointments, and diet, is necessary for success with this type of disease. Patients: feel encouraged to ask questions, seek education, and manage your condition so not to feel as though your condition manages you. Educate yourself. Conquer your condition. We can help. – Aanchal Kumar Thadani, Pharm.D.


Resources: The American Diabetes Association www.diabetes.org, The Glycemic Index and GI Database www.glycemicindex.com.