ASH Practice Update

The following information is provided by the American Society of Hematology (ASH) and is fully available at http://www.hematology.org/policy/practice/04102008.cfm.

ASH to Meet With Senate Finance Committee Chair Baucus to Discuss New Medicare Bill
Senate Finance Committee Chair Max Baucus (D-MT) is developing a bill that would delay the scheduled 10 percent reduction in physician reimbursements for 18 months. It is anticipated that this bill would cost $8.4 billion over five years and give physicians a 1 percent payment increase through 2009. While it would halt the 10 percent pay cut scheduled to go into effect July 1, the measure would provide "balloon financing" so that a 21 percent pay cut would go into effect January 1, 2010.

ASH previously reported on and endorsed Senator Debbie Stabenow's (D-MI) bill, the Save Medicare Act of 2008 (S.2785). The Stabenow bill would provide a 0.5 percent update through the end of 2008, averting the July 1 anticipated 10.6 percent cut. This bill would give physicians a 1.8 percent payment increase for 18 months without balloon financing language, which sets up higher pay cuts in the future to compensate for temporary changes. The Congressional Budget Office says that such a proposal would cost almost $40 billion over five years and $84 billion over 10 years. Unlike the Baucus bill, this bill does not include balloon financing, so physicians would not be faced with a pay cut in 2010; however, the bill does not specify how the increase in physician fees would be paid.

At this point, the major controversy with legislation to avert physician payment cuts is how to pay for it. Chairman Baucus has opted for balloon financing. Senator Stabenow has not specifically identified a financing mechanism, and Finance Committee Republicans have conditioned their support for any 18-month fix on negotiators' ability to agree on offsets but are not willing to decrease federal payments to Medicare Advantage plans. Under current law, this year's Medicare Advantage plan payments are projected to be 13 percent higher than payments to traditional Medicare plans.

ASH will be meeting with Chairman Baucus on April 11 and will keep the practice community apprised of all developments.

Participate Today - ASH Practice Survey
The ASH Committee on Practice is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey, and help ASH better understand the needs of the hematologist practitioner. All surveys must be completed by April 30. Results of the survey will be shared in June.

Medicaid Tamper-Resistant Prescription Pads Requirement Effective April 1, 2008
On April 1, 2008, the first phase of the new requirement on the use of tamper-resistant prescription pads in the Medicaid program went into effect. To be considered "tamper-resistant," prescription pads must contain at least one of three characteristics by April 1, 2008, and all three characteristics by October 1, 2008. These baseline characteristics are: (1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form; (2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription pad by the prescriber; (3) One or more industry-recognized features designed to prevent the use of counterfeit prescription forms. States are free to exceed the above minimum standard as to what constitutes a tamper-resistant prescription pad. Each State Medicaid agency has issued its own guidance on this requirement and this information can be obtained by contacting the state Medicaid agencies.

The limitation on payment and the requirement for the use of tamper-resistant prescription pads does not apply to: (1) Drugs provided in nursing facilities, intermediate care facilities for the mentally retarded, institutions for mental disease, and other specified institutional and clinical settings; (2) Prescriptions that the managed care entity pays; (3) Electronic prescriptions transmitted to the pharmacy; (4) Prescriptions faxed to the pharmacy; or (5) Prescriptions communicated to the pharmacy by telephone by a prescriber. In addition, a pharmacy may fill an entire prescription on an emergency basis provided that the prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled. Refer to the CMS Frequently Asked Questions document for more information. CMS will be monitoring implementation progress to assure a smooth transition.

Congress Requests Information on Marketing, 'Bundling' Contracts for Anemia Medications
The House Energy and Commerce Committee has submitted a letter to Amgen and a letter to Johnson & Johnsonrequesting information on marketing and "bundling" contracts related to anemia medications. The intent of these requests is to investigate the ability of the Food and Drug Administration to protect the public from excessive risks from prescription drugs.
Specifically, the Committee requested information on the amount that Johnson & Johnson has spent on consumer television and print advertisements for the drug Procrit since 2001. The Committee is also asking for an explanation of the decision to discontinue the ads for Procrit in 2005.

The Committee has requested different information from Amgen, which does not advertise Epogen and Aranesp directly to consumers. The Committee seeks copies of contracts in which Amgen provided discounts on Neupogen and Neulasta to physicians who prescribed Aranesp. The Committee also has requested copies of television and print ads for both Neupogen and Neulasta.

Medicare Issues Final Rule on Electronic-Prescribing for the Part D Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) released its final rule for establishing standards on electronic prescribing under the Medicare prescription drug benefit. The rule establishes standards for the electronic transmission of information on the medications covered under the Medicare prescription drug plans of beneficiaries and the availability of generic versions of those treatments. The standards allow physicians and other health-care providers, pharmacies, and Medicare prescription drug plan sponsors to share information about medications taken by beneficiaries. In addition, the standards allow pharmacies to inform physicians and other providers when patients obtain their prescriptions. The rule does not require physicians, pharmacies, and other providers to adopt e-prescribing in order to participate in Medicare.

This final rule on Part D e-prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e-prescribing foundation standards (CMS-0011-F) will be available online.

State Legislatures Require Reporting of Drug Company Physician Gifts
In recent months, state legislatures across the country have begun introducing legislation requiring pharmaceutical companies to report the value of meals, travel, and other gifts and perks that they provide to physicians. Many legislatures' bills are in the mold of Arizona SB 1250, which was recently introduced in the Arizona Senate. The bill requires, on pain of hefty fines, that all drug manufacturers disclose the total cost of marketing their products in the state as well as all promotional expenses, food, travel, and gifts to health-care providers that are of more than $25 value. Reimbursement associated with clinical trial expenses is generally exempt from this requirement. Similar legislation is currently in force in only a handful of states, but more than a dozen state legislatures are currently considering such bills. In addition, a few states have gone even further.

The Massachusetts, California, and Illinois legislatures are all considering bills that would ban nearly all drug company gifts of more than nominal value. ASH will continue to follow this important issue and keep its membership apprised of any new developments.

Consumers, Health Care Purchasers, Physicians, and Health Insurers Unveil Agreement on Principles for Physician Performance Reporting
Leading consumer, employer, and labor organizations, in collaboration with leading physician groups and health insurers, have developed the "Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs." This charter creates a national set of principles to guide measuring and reporting to consumers about doctors' performance.

The charter has broad support including from the American Medical Association, American College of Surgeons, Aetna, Cigna, United Health Group, Wellpoint, America's Health Plans, AFL-CIO, and AARP.

Key points that address the needs of consumers and the concerns of doctors include:

Consumers can make informed decisions based on quality and cost, with guidance about how to use the information and an understanding of limitations on the data.

Measurement is based on sound national standards and methodology.

Both consumers and physicians have input into the measurement process and reporting of results to assure that the information is trusted by physicians and meaningful to consumers.

Measurement is a transparent process so that both consumers and physicians can understand the basis upon which performance is being measured and reported.

Physicians have adequate notice and opportunity to correct any errors.

Physicians will have information that helps them improve the quality of care that they provide.

For additional information, visit the Consumer-Purchaser Disclosure Project's Web site.