November - New York City Pharmacists Society

N E W S L E T T E R
Designed, Printed & Mailed by:
KEOS INC.
NEW YORK CITY PHARMACISTS SOCIETY
631-521-7043
AN AFFILIATE OF THE PHARMACISTS SOCIETY OF THE STATE OF NEW YORK
The Voice of Pharmacy in the Big Apple
www.NYCPS.org
VOLUME 16, ISSUE 8
OFFICERS
Jim DeTura, President
718-292-1856
Charlie Catalano, Vice Pres.
718-358-1300
Bill Scheer, Treasurer
718-655-5558
Jim Schiffer, Secretary
212-616-7040
EXECUTIVE DIRECTOR
James A. De Franco
718-893-2400
BOARD OF DIRECTORS
Russell Gellis, Chairman
212-877-3480
Bill Scheer,
718-655-5558
Mike Agovino
718-543-3116
Ron DelGaudio
718-230-3535
Michael Escuder
212-213-5570
Adelso Fernandez
212-304-9582
Ray Macioci
718-823-1085
Boris Mantell,
718-591-1040
John Navarra
212-213-5570
Joseph Navarra
212-213-5570
Alex Perchuk
718-835-2000
Rajan Pillay
212-927-0220
Mohammed Saleh
718-493-8118
PSSNY REGIONAL REPS
Ray Macioci
Bronx, Manhattan
Ron DelGaudio
Brooklyn, Staten Island
Mike Escuder
Queens
RECORDING SECRETARY
Rosemarie Tomasseti
917-750-6273
TABLE OF CONTENTS
President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Important Notice on Cross Over Medicaid . . . . . . . . . . . . 3
I’m Banking My Time On You. . . . . . . . . . . . . . . . . . . . . . 4
Secretary’s Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Thank You Dilip Patel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
The NCPA Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
PAAS Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
News from Around the Pharmacy World . . . . . . . . . . . . 11
Legal War Chest Update . . . . . . . . . . . . . . . . . . . . . . . . 16
PSSNY HELPLINE 1-800-632-8822
SENIOR EDITOR
Jim Schiffer
NOVEMBER 2007
PRESIDENT ’S MESSAGE
THE WAR OF THE WORLDS
O
n October 30, 1938 a very
interesting and historic
even took place. Orsen
Welles directed an adaptation of H.
G. Wells’, “The War of The
Worlds.” Many people had not
heard the opening credits and
picked up the broadcast a bit later
on. What they believed they heard
was a live account of a Martian
invasion here on Earth.
There
were reports of panic and even
people fleeing from their homes.
Even until this day, this event
marks its place in history.
What does this have to do with
pharmacy you may ask? Well I ask
you to read on and while you do,
ask yourself, “Is this reality or fiction?”
At our last continuing education program and regional meeting held on October 25th. we had
a very good turnout of about 170
pharmacists. During the regional
meeting portion of the event, our
Bronx regional representative,
Ray Macioci brought everyone up
to date on many issues affecting
our profession. Some of these
issues centered on the enormous
audits brought down by the
Medicaid Inspector General’s
office regarding MMIS numbers,
“dead recipient” letters, other
insurance subrogation and failure
to report the SP pharmacist to
Medicaid. Ray was very eloquent
and direct in his approach. At one
continued on page 14
Legal War Chest Round # 2 . . . . . . . . . . . . . . . . . . . . . . 17
Page 3
Important Notice on
Cross Over Medicaid
- Medicare Claims
U
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A
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EL Page 8
T
A
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The New York City Pharmacists Society
41 E. 11th Street, 11th Fl., New York, NY 10003
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PAGE 2 NOVEMBER 2007
NYCPS NEWSLETTER
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 3
IMPORTANT NOTICE ON CROSS OVER
MEDICAID - MEDICARE CLAIMS
I
f you are a pharmacy provider in the New
York Medicaid Program that is designated as a “Swiping Pharmacy” then when
you are billing Medicaid for the 20% of
Medicare Part B billings, be aware that the
various billing agents such as OmniSys have
been electronically submitting these bills to
Medicaid under the DME portion of your
Medicaid account (provider type # 442) .
Medicaid would accept these claims either
under pharmacy billing #441 (where no service authorization is needed) or DME billing
#442,
but
unfortunatley
NYS Medicaid
continues
to
require claims
submitted
under #442 to
establish
a
“ S e r v i c e
Authorization”
before
payment will be
made to you
(only required
if your pharmacy is designated
as
a
“ S w i p i n g
Pharmacy”).
You can establish a Service
Authorization
(“SA”) by creating a transcation type 6 on
the EMEDNY
Trans
3740
machines.
Without the SA
established
within 60 days
of the posting,
all of these
claims
will
eventually
deny. These claims will initially pend for up
to 60 days from the date of posting by
Computer Scieces, and depending upon your
Medicare billing agent, there is traditionally a
two to three week lag time from the actual
dispensing to the cross over Medicaid billing
creation. Please pay attention to your billing
process of the Medicare claims agent you
have chosen to process claims for your pharmacy.
Jim Schiffer
PAGE 4 NOVEMBER 2007
NYCPS NEWSLETTER
“I’M BANKING MY TIME, ARE YOU?”…..AN
INNOVATIVE PARTNERSHIP OPPORTUNITY
VNSNY Community Connections TimeBank
Visiting Nurse Service of NY (VNSNY) is
pleased to share some exciting news with all the
members of the NYC Pharmacist Society. We
have just celebrated the first anniversary of the
launch of the VNSNY Community Connections
TimeBank and we are inviting you to consider
collaborating with us as we expand it to neighborhoods throughout New York City.
A TimeBank is a community of local residents who exchange a wide variety of services
(typically non-licensed services). Whether it is
picking up a prescription, helping a member get
to the doctor, providing childcare, help with groceries, or minor home repair, crocheting a blanket, teaching a computer class, or checking in on
a homebound person, each member’s time is valued equally. For every hour contributed,
TimeBank members earn one time credit, which
can be redeemed for services from other
TimeBank members.
Visiting Nurse Service of NY (VNSNY)
rolled out its own TimeBank in December 2006
to help build community supports for people in
Washington Heights/Inwood. Based on the success uptown, VNSNY will launch a second
neighborhood TimeBank on the Lower East Side
of Manhattan in the spring of 2008 as well as in
other boroughs soon thereafter.
The TimeBank is structured to include people of all backgrounds, ages, and levels of ability, including older adults, teenagers, parents, and
people with physical disabilities. Members who
are homebound can contribute in many ways
including calling other homebound members,
sending out birthday cards, or making a blanket
for someone who is sick. There are many stories
of homebound TimeBank members who have
saved the life of a phone partner by calling for
help when he or she did not answer the phone.
The VNSNY TimeBank is Washington
Heights/Inwood has already enrolled over 250
members (there is no fee to join) and is working
closely with 20+ community organizations. In
addition, it has built the largest network of
TimeBank business partners with over 70 local
and 10 regional businesses onboard offering discounts to the TimeBank members. These businesses include local pharmacies, car services,
groceries, restaurants and clothing stores. In
addition to becoming a TimeBank business partner, many owners as well as their employees
have enrolled as individual TimeBank members.
TimeBanking is all about building and preserving relationships and healthy communities
that support the residents and the local economy.
It is all about building trust. The individual pharmacist is in the unique position of having strong,
trusting relationships with local residents and
leaders and is therefore a natural partner to a
TimeBank.
The VNSNY TimeBank model was presented to and well received at the last meeting of
the Board of Directors of the NYC Pharmacist
Society. Two pharmacists from Washington
Heights/Inwood were present at the Board meeting and both will be discussing potential partnerships with the TimeBank.
We encourage all pharmacists to contact the
TimeBank at 212-609-7811 for more information about the VNSNY TimeBank. We would be
happy to share with you some of the articles that
have appeared in the local paper as well as in
Kiplinger’s Retirement Report. Let us know if
you think the TimeBank could benefit you, your
family, your customers and residents of your
neighborhood.9
by Mashi Blech, Director
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 5
PAGE 6 NOVEMBER 2007
SE C R E T A R Y ’S
REPORT
NYCPS NEWSLETTER
thought knew the economic
problems that community pharmacies face.
Let me walk down memory
NOV
lane
with one and all, as I had
2007
reported last year, in June 2006
a private meeting was arranged
nother year is coming to a close. for NYPCS by our friend, Mr. Stewart
This past year has been a very Rahr owner of Kinray. The meeting was
stressful one for New York phar- between candidate Spitzer and myself,
macists. With a new governor, from a Ray Macioci, and Mr. Rahr. We sat and
different political party, replacing our spoke with Mr. Spitzer in a NYC hotel
twelve year term of outgoing republican lobby for about 20 minutes and disGeorge Pataki, we in the pharmacy pro- cussed the state of pharmacy affairs in
fession were hopeful that we would be New York State. After this meeting and
subject to a more sympathetic adminis- our follow up discussions with his senior
tration and leader in the governor’s man- staff, it seems he has a short memory.
sion in Albany. It was not too long into Ray and I explained to Mr. Spitzer how
January that we found out differently. the PBM’s are financially beating us up,
Pataki may not have been our friend, but and how we are at wit’s end in trying to
Spitzer is not either. He immediately find means to economically survive in
introduced a budget where he wanted to this tough economy, especially with the
reduce pharmacy reimbursement for constant battle we have with PBM conMedicaid, ADAP and EPIC, to new trolled mail order factories intrusion
record lows and in exchange he offered a into our patient base, add the increased
slight increase in the dispensing fee.
competition from the national pharmacy
After a short fight with our few chains, the shrinking margins we face on
political allies in Albany, we wound up reimbursement, the expansion into NYC
with the passage of a new budget for of big box discounters destroying our
New York State on April 1, 2007 - - the OTC and HBA business along with
first time in many years that the budget increased costs associated with fuel and
was passed and signed into law by the increased costs with general operating
governor on time , by April 1, - - and expenses.
then we saw the cuts, AWP minus 14%
Let us not forget the background
instead of the minus 15% but the knowledge that Governor Spitzer has
increase in the dispensing fee was elimi- accumulated as he spent eight years as
nated. This all from a governor that we
A
STERLING & STERLING, INC.
I N S U R A N C E
Protecting People From Adversity
Adversity
STERLING & STERLING, INC.
Mr. Bill Adams and Mr. David Epstein
P.O. Box 9017, 45 Crossways Park Drive,
Woodbury N.Y. 11797
(516) 487-0300 or (800) 767-7837
Fax: (516) 487-0372
New York State Attorney General in
fighting for the little guy. Spitzer
attacked Dick Grosso, of the New York
Stock Exchange, insurance companies,
giant corporations, the drug industry and
especially the PBM’s - - as Spitzer took
on Express Scripts for their scheme in
pricing drugs billed to sponsors at one
price and paying the pharmacist a fraction of that billed price- - all in the name
of the citizens of New York State. What
hurts us is to hear from senior policy
makers of Governor Spitzer’s management team are comments like, “after all,
you know Mail Order is cheaper anyway”, and it makes you scratch your
head in bewilderment at their understanding of the issues.
I would describe the state of affairs
for pharmacy in New York State as turbulent, with what appears to be more trouble brewing in the 2008 year. Just look at
the recent announcement by Medco that
the New York State Government
Employees who are currently covered by
Caremark for their medications will be
switched on January 1, 2008 to Medco.
What will the 2008 reimbursement for
these patients? Currently we are getting
very low MAC prices on generics (below
actual cost on items like Albuterol
inhalers, and Meprobamate tablets),
along with 17% off of AWP for all branded products which you can dispense up to
a 90 day supply. What is confusing is
continued on page 13
Protecting
Pharmacists
For Ov er 60 Years!
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 7
PAGE 8 NOVEMBER 2007
NYCPS NEWSLETTER
THANK YOU DILIP PATEL!
A
s you know for nearly 14 years
the finances of NYCPS have
been in very capable hands, the
hands of Mr. Dilip Patel our dear friend
and colleague. Although Dilip has not
been working as a full time pharmacist
of late, nevertheless, he maintained his
close relationship with NYCPS and has
kept our books in tip top shape. You
may not know that he has offered his
resignation on several occasions, and
on each prior occasion, without a qualified and capable volunteer willing to
step into Dilip’s shoes, the NYCPS
Board has asked
Dilip to stay put
as our treasurer.
Now that Bill
Scheer has completed his long
tenure of assending
various
PSSNY offices
up to and including
PSSNY
President
and
Chairman, Bill
has offered to
step up and fill
the position as the
N Y C P S
Treasurer. At the
October
2007
NYCPS Board
Meeting,
the
Board unainomusly approved
the motion to
install Bill Scheer
to serve the unexpired term of
treasurer.
On behalf of
the
NYCPS
Board, I want to
personally thank
Dilip for his sincere friendship,
his dedication,
hard work, dili-
gence, ethics, integrity as NYCPS
Treasurer and efforts to help NYCPS
grow to become the strong voice for
community pharmacy not just locally,
not just in New York State, but nationally we have become recognized as the
voice and the soul of community pharmacy and the community pharmacy
owners. To those of you who do not
know this, Dilip saw us through some
lean times, some tough times, particularlly through the Aetna US Healthcare
lawsuit, were we went after one of the
largest insurance companies in the
United States, and Dilip had to track
nearly $90,000 in contributions from
pharmacists not just from New York,
but from other states, who learned of
our fight against this insurer, all donations were returned to the donors at the
conclusion of the legal battle, a task
which in itself was a bookeeping nightmare. After the settlement of the Aetna
US Healthcare Lawsuit, Dilip then had
the wisdom to suggest to the NYCPS
Board to create a Legal War Chest - - to
be funded by volunteer contributions - so that NYCPS would have the financial resources to fight the bullies trying
to destroy community pharmacy. 9
THANK YOU DILIP!
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 9
T HE N C P A R E P O R T
109th Annual NCPA Convention Wrap-Up
It sounds like a cliché, but our 109th annual convention in Anaheim was the most exciting
and productive one yet. By the time the festivities over 3600 pharmacy professionals found
time from their busy schedules to interact with
each other, learn about news trends, and develop
a strategy to meet the challenges we face going
forward. Approximately 600 pharmacy students
were in attendance, which bodes well for the
future of independent pharmacy that young people are this engaged at this level.
I’m not going to tell you that we solved all
of pharmacy’s problems at our convention, but
we continue to make progress by laying the
foundation for a brighter future.
One of the ways to bring about a brighter future
is to ensure our voice is heard in the corridors of
power in Congress. Two years ago we set a goal
to have one of the top 50 trade association PACs
in the country. At this year’s meeting, we raised
over $100,000 which helped us reach that goal
we set in 2005. We’re now closing in on a $1
million war chest to help us elect a community
pharmacy majority in Congress. If you are one of
the hundreds of pharmacists who helped make
this goal a reality, thank you.
While we were at the convention, we
crossed an important milestone in our campaign
to get Medicare prompt payment legislation
enacted. A bipartisan majority of the House, over
224 members at last count, have cosponsored
H.R.1474, Fair and Speedy Treatment (FAST) of
Medicare Prescription Drug Claims Act of 2007.
That is a huge accomplishment and should soon
spur action.
During the convention Senators Johnny
Isakson (R-Ga.), Tim Johnson (D-S.D.) and
Lindsey Graham (R-S.C) introduced S.2161, the
Community Pharmacy Fairness Act of 2007. The
bill creates a narrow exemption to antitrust laws
that empowers community pharmacies with collective negotiations rights that end the take-it-orleave-it contracts of the giant PBMs.
We also are continuing to make good
progress on our third major priority on Capitol
Hill—Medicaid AMP fix legislation before the
severe cuts to reimbursement are felt in early
2008. We also decided to address another problem confronting community pharmacies—the
growing prevalence of robberies. A campaign
will be launched to remind community pharmacists and local law enforcement officials that
under a 1984 law a pharmacy robbery or burglary is a federal crime punishable by up to life in
prison and a $50,000 fine. The effort is called for
in one of the 14 policy resolutions adopted by the
House of Delegates at the convention.
The conference provided pharmacists educational programs about the very latest therapies and
technologies available to help better serve their
patients. Pharmacists learned about niche programs, new technologies, expanding opportunities in medication therapy management, and the
patient safety benefits of electronic prescribing
in places such as the trade show exposition,
which featured more than 200 vendors.
Among other highlights were general session speakers included Academy Award-winning
actress Geena Davis and former Major League
baseball pitcher Jim Abbott. This year’s political
forum featured veteran columnists and commentators Robert Novak and Mark Shields who provided their takes on the political landscape as we
approach the 2008 elections. The conference
closing night party had a Hollywood-theme featuring Saturday Night Live comedian Darrell
Hammond, who is well-known for his impressions of politicians and entertainers.
At the convention, changes were made to
our leadership team: Steve Giroux of Upstate
New York is our new president and Joe
Harmison of Texas is chairman of the Executive
Committee. Holly Henry of Seattle is presidentelect. New to the team are David Smith, 4th vice
president, and Bill Osborn, 5th vice president.
Sharlea Leatherwood, NCPA past president, is
the new president of the NCPA Foundation with
Charlie West, past NCPA executive vice president, remaining as an NCPA Foundation board
trustee. And, I’d like to thank once again immediate past president John Tilley and his wife
Karen for all their hard work on behalf of NCPA
in 2006-07.
Next year’s meeting is in Tampa. If you
haven’t been to one of our meetings or haven’t been
in a few years, don’t miss another golden opportunity to take part in the networking, business opportunities, and entertainment next October. 9
By Bruce Roberts, RPh,
National Community Pharmacists Association, NCPA
Executive Vice President and CEO
PAGE 10 NOVEMBER 2007
PAAS REPORT
Safe Billing Tip: 90-Days Supply
To safely dispense and bill a 90-day supply, make sure
you have a prescription written for a 90-day quantity. Now that a 90 day supply can be billed to
many Third Parties, pharmacists may
believe they can exceed the quantity to
dispense written on the original prescription to accommodate the
patient. Even if the prescription is
refillable, you should not exceed the
dispensing quantity ordered by the prescriber. Doing so can result in a very expensive “Dispensed Greater Than Rx” audit recoupment. Any time the quantity dispensed exceeds the amount
the doctor ordered, auditors will recoup money.
For example, if you dispense a quantity of 90 for a prescription written for Fluoxetine 40mg #30, 1 cap q.d. with prn refills
the Third Party will likely charge back the price of 60 capsules
when that claim is reviewed as part of an audit. You are limited
to dispensing 30 capsules unless you contact the prescriber to
obtain a new prescription with a dispensing quantity of 90 or
thoroughly document the prescriber’s authorization on the original hard copy of the prescription. PAAS strongly recommends
that a new prescription be created rather than amending the old
order.
NYCPS NEWSLETTER
Loading Dose and Ramping Dose Quantity Errors by Tim
Hensch, CPhT
Audit charge backs for incorrect day supplies for loading
dose or ramping sigs are becoming more common. Prescriptions
written for a loading dose or a ramping sig may lead the pharmacy to dispense the wrong quantity when refilling the Rx. An
example of a loading dose Rx is Vagifem with a sig
of “Insert one tablet vaginally daily for the
first two weeks then one tablet twice
weekly.” Pharmacies may incorrectly
refill this prescription with an 18
count box of Vagifem. An example of
a ramping dose Rx is Metformin
500mg with a sig of “Take one tablet
daily for two weeks, then one twice daily.”
Pharmacies may incorrectly fill this Rx with a
quantity of 60 during the initial fill.
The following procedure may prevent over dispensing these
medications:
Create an initial and separate hard copy, with no refills, for the
initial fill.
Repeat this process for each refill until the regimen stabilizes.
Create a separate Rx# and hard copy with remaining refills once
the regimen has stabilized.
PAAS believes you can prevent these types of audit charge
backs by billing accurate day supplies that are justified by your
prescription hard copies
continued on page 13
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 11
JIM SCHIFFER REPORTING...
N
ber
m
e
v
o
2007
News from Around
The Pharmacy World
NOVEMBER 2007 EDITION
NCPA & NACDS Sue US HHS /
CMS
over planned AMP
Implementation
In early November the combined
efforts of the National Community
Pharmacists Association and the
National Association of Chain Drug
Stores were forged together into a
lawsuit filed in federal district court
in our nation’s capital in an attempt
to delay and or change the way the
U. S. Health & Human Services
(“HHS”) agency, Centers for
Medicare and Medicaid Services
(“CMS”) planned implementation of
Average
Manufacturers
Price
(“AMP”) strategy, which will then
become the benchmark for reimbursement of state Medicaid claims
for generic drugs, and as many folks
fear, will be copied by the pharmacists best friend, the PBM industry.
We have well been made aware of
the nightmare scenario that probably
exists under AMP pricing strategy
by our national pharmacy leaders.
What is a major concern, after all, is
the government’s inclusion in the
AMP calculations are the prices
charged (after rebates) to mail order
“factory” pharmacies ( note that it is
my emphasis is on the factory
aspect, because that is how I regard
mail order pharmacies, as dispensing
pharmacy factories). The inclusion
of mail order rates will serve to
greatly reduce the actual prices that
will be used for calculating reim-
bursement to community pharmacies under state Medicaid programs,
and community pharmacies do not
have access to these deep discount
mail order factory rebates. This is
just one example of a major and serious flaw in this methodology which
our famous Uncle Sam appears to
have screwed up, other examples of
the flaws are the lack of requiring
timely reporting of market changes
for raw material, (remember the
Lorazepam debacle) and the lack of
tracking shortages of generic products in particular regions of the
country besides other important
issues which have not been
addressed by this congressional
mess!
By way of history, as you may
be aware, many years ago under the
Ford Administration in the 1975,
and took us into the Carter
Administration in the late 1970’s to
finally approve the list of initial federal Maximum Allowable Price
(“MAC”) pharmaceuticals priced at
a flat rate. Ampicillin, Penicillin and
generic Lomotil were three of the
dozen or so pharmaceuticals listed
on this list. This issue was long
before the massive list of generics
ever entered the marketplace. Back
in the period of time when MAC
pricing came about, the government
had concern about the “professional” dispensing fee that pharmacists
were paid in addition to the ingredi-
ent cost on their prescription dispensings. Court cases were a common thing about states not updating
the payment of a dispensing fee.
There were federal court cases
brought in New York and in
Pennsylvania by the pharmacy
organizations and both cases resulted in modifications to proposed or
actual cuts in reimbursement. In
contrast to today’s government attitude on all levels, one has to wonder
if there is a concern at all about the
economic survival of pharmacists
participating in government sponsored prescription programs. Time
will tell if AMP will be implemented as it is currently planned, or if it
will be modified somewhat, or
scrapped entirely. After all, the congress acted quite fast in late October
regarding the tamper proof blanks
when there was a real threat to
patient access to medications, as
they passed emergency legislation
delaying the implementation of the
tamper proof blanks for a six month
period. President Bush even signed
the bill into law, another surprise.
AMP will it come or not? The shadow may know, but I cannot venture a
guess at this time!
Other National Pharmacy Issues
The
Food
and
Drug
Administration is once again considering the creation of a third class of
drugs which would only be sold
continued on page 12
PAGE 12 NOVEMBER 2007
NYCPS NEWSLETTER
AROUND THE PHARMACY
FROM PAGE
11
under the supervision of a pharmacist. As the Plan B product is limited
to be sold over the counter to anyone
over the age of 18, by a pharmacist
only, the FDA is now considering the
value of placing other pharmaceutical products behind the counter of a
pharmacy, to be distributed exclusively under the direct supervision of
a pharmacist. All of the national
pharmacist organizations who were
asked to testify before the FDA did
so expressing positive comments on
this draft proposal.
Moving onto other national
issues, one of the cornerstones for
community pharmacy survival, the
proposed legislation – drafted by NY
Congressman Anthony Weiner - which if enacted would under special
and limited conditions authorize
pharmacists to negotiate payments
with the PBM and Prescription Drug
Plan industry received a boost from
the House Judiciary Committee when
the bill was voted out of committee
on a voice vote, which means without
resistance, in early November.
Although this proposed legislation
appears to have been watered down –
the proof will be in the final language
of the bill- this landmark legislation
known as H.R. 971 (“HR”. signifies
House of Representatives version of
a proposed bill, versus a “S” which
would relate to a Senate version of a
proposed bill) would permit collective groups of independent pharmacists to negioate with various payors,
including Medicare Prescription
Drug Plans (“PDPs”) and the commercial world of Pharmacy Benefit
Managers (“PBMs”). Before we can
break open the champagne, we must
recognize that this bill does not have
a Senate sponsored mirror image
linked bill so having a compromise
bill is still something that needs quite
a bit of work. Additionally, there are
some serious concerns about this bill
as written and passed by the House
Judiciary Committee. First of all, the
reason for this bill to be introduced in
the first place was to help even the
playing field and help the independent pharmacy community negioate
with the huge interests of the PBM
and insurance industry. Also, initially, as this bill was being crafted by
Weiner there was no concern for protecting the regional and national drug
chains from the PBM and insurance
industry as these drug chains are
large, publicly traded companies that
exert their own market power.
Congressman Weiner has been an
outspoken supporter of independent
pharmacies and has even criticized
the drug chains for the ways in which
they operate.
However, for some reason, - possibly to get this bill out of committee- - , there were many changes
made to the language of HR 971- which appear to have diluted the real
negotiating effect of HR 971.
Changes which include drug chains
of any size in the negotiations
process.
Also any pharmacy
involved in the proposed negiogations process cannot control more
than 10% of the market of a
Prescription Drug Plan region. (Not
every state is independently considered a PDP region, as some states
like North and South Dakota are considered together as one PDP region).
Additionally as this revised draft bill
states, no group of pharmacies that
are intended to partake in negiogations under this propose bill can represent more than 25% of all of the
pharmacies in that particular PDP.
There are some states where the independent pharmacies represent 80% to
90% of the total number of pharmacies operating in that PDP region.
Therefore these independent pharmacies must be grouped in two or three
various negotiating groups, and
maybe will be negotiating against
other independent pharmacies in
their respective PDP. Why did this
occur? Maybe the congressional
leaders pushing for this bill felt it was
not going anywhere without these
modifications, and a half a loaf of
bread is better than no bread at all.
Besides the issues that I have
spelled out here, it will take some
real political muscle to continue our
movement of this bill through the full
House of Representatives, get a vote
of approval by the full House and
then get a similar bill passed through
a Senate committee and then again in
the full Senate, let us not forget to
then have President George Bush
sign this controversial bill into law.
By the way, word on the streets of
Washington D.C., has it that Senator
Patrick Leahy of Vermont - - who
controls the Senate Judiciary
Committee - - is not really interested
in protecting the independent pharmacies of this country and he has little or no interest in pushing for this
bill in the Senate. Nevertheless, I
like many other community pharmacists appreciate the hard work that
Anthony Weiner has exerted on this
issue for the neighborhood pharmacist.
This is not the only bill that is on
the agenda of NCPA and other community pharmacy organizations. We
are pushing for the “FAST” legislation, which stands for “Fair and
Speedy Treatment”, sponsored by
our friend, Mr. Walter Jones of North
Carolina. This bill pertains to pharmacists payments in the in the Part D
world of dispensings. We are hopeful that Congress will authorize the
language of this bill which includes a
prompt pay bill provision for clean
claims from Medicare Part D and
also will set minimum rates of prescription dispensing fees. This bill
has not received the congressional
interest nor traction that the Weiner
Bill has attracted, in spite of the
importance of this bill to the survival
of independent pharmacies.
continued on page 19
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 13
Secretary’s Report
from page 6
why is New York dumping Caremark?
In March of this year, your leadership of
NYCPS met with senior policy makers
of Governor Spitzer who put us in touch
with state managers of the NYSHIP RX
program.
The director personally
bragged to me how the state was getting
a truly transparent price on the drugs and
finally the state was getting the bargain
they deserve for their volume of purchasing.
What made the state dump
Caremark in favor or Medco? How will
independent pharmacies be able to compete with a 22% discount on long term
PAAS:CONTINUED
FROM PAGE
10
Fraud, Waste and Abuse Training
By now, most of you have received
notice from one PBM or the other that you
should have a Fraud, Waste and Abuse
training program implemented and documented for your pharmacy. CMS requires
that PBMs contracted as PDPs for Medicare
medications? We have not had an explanation from NYS yet. Will we get one?
The shadow knows!
As we go to press we are left
scratching our heads on this issue.
Additionally it appears that HIP of New
York (and also Local 237 who is managed by HIP) has modified their 90 day
pricing for certain patients who had been
priced for branded drugs at AWP minus
14% discount and now appear to be all
placed at a AWP minus 22% formula. I
have made several calls to HIP and have
not been given any logical explanation
as to their action. It seems like they
don’t care to respond to legitimate pricing questions interested. What is going
on? Call HIP and protest if that is not
what you should be paid, you need to
express yourself and not stand by and
take these hits!! At press time, your
NYCPS leadership is fighting for your
and trying to figure it all out.
As it seems, things are unraveling
faster than we can monitor them. I predict Spitzer will be looking for a new job
in a little more than 3 years. I don’t think
he will be worried about driver licenses
either. Someone must have whispered in
his ear to give it up. Folks keep the faith,
as tough as it is. And keep us informed
of your issues and concerns.9
Part D have this training for their employees
and to ask that all downstream entities
(that’s you) also have a program in place.
PAAS has created a document that may be useful as you attempt to comply. It includes CMS’s
examples of what constitutes pharmacy fraud,
waste and abuse and the text can be copied for
inclusion in your written policy. The document
provides links to CMS’s Chapter 9 FWA pdf and
also provides suggestions for sources of on-line
computer based FWA training.
PAAS is pleased to provide this information to
our members. To receive
your copy of the PAAS
two page FWA document
via e-mail send your
request to [email protected] and include
FWA in the subject line
along with your store
name, NCPDP# and NPI#.
Software: Your Silent
Gremlin
Your pharmacy’s dispensing software may
be undermining your
attempts to fill and bill
third party prescriptions accurately. It is
imperative that you
ensure your software is
up to date and is set up
to facilitate meeting
third party require-
ments. Your software may be set to
default to flags that require documented proof. These overrides should be
reset to require input by the pharmacist or technician based on hard copy
documentation.
Be careful using the “renew” function as this may transfer information that
appeared on the first prescription hard
copy and not on the latest. Some pharmacy dispensing software will continue
to present a “vacation” override on every
refill following the original request, thus
eliminating “early refill” warnings from
the third party’s adjudication system.
PAAS members have also experienced “Wrong Prescriber” audit discrepancies due to their software substituting
a linked supervising physician’s ID in
place of the PA or NP who wrote the
prescription, without alerting the pharmacy that this substitution was occurring. The fill sticker shows the PA’s or
NP ‘s ID but the software company
transmits the ID from the supervising
physician that they are linked to.
Many pharmacy owners assume that
their software meets every third-party
requirement, and discover too late that
their computer system is defaulting to
“documentation required” flags. PAAS
reminds you to verify the accuracy of the
information before transmitting to the
third party. Don’t make the mistake of
assuming your pharmacy dispensing software is smarter than you are! 9
Jim Schiffer
©2007 James R. Schiffer
PAGE 14 NOVEMBER 2007
which were sent. I also understand that another 1000 letters
are
waiting to go. And if you
FROM PAGE 1
were not at the meeting, I
point he asked if anyone had received one of those 1st 100
received any of these audit let- letters and I am fighting the
ters from the MIG. Between audit with legal counsel. Those
Ray, myself and Charles who rolled over and paid it
Catalano, (Queens rep.), we thinking you would keep
saw 2 hands raised. Ray then Medicaid off your back, you
asked how many present were should have thought otherwise.
pharmacy owners? It appeared You are an easy mark for them
to me that about 1/3 raised their and like a bad cold, (or inhands. Moments later I made laws), they WILL return. Keep
another appeal. I prefaced my something very important in
question by stating that your mind. The MIG must recoup
society is here to defend the $1.6 billion by 2011 or lose the
rights of our profession. That matching federal funds attached
we are being open and honest to that. Now it does not take a
with our members and in turn rocket scientist to figure out
we need our members to be Medicaid’s approach that it is
open and honest with us. I made easier to get it from us pharmait very clear we were not taking cists by many of the means we
names nor were cameras are experiencing than by corrolling. We just need to know recting the system and doing it
what impact this is having right. Case in point: Purdue
amongst our members.
We Pharma recently paid $635 milwanted to show the reality of lion for misleading the public
the situations facing us today. I regarding the marketing of its
even stated, “I cannot believe highly
profitable
drug
only 2 people out there have Oxycontin.
Recently
received these letters!” Once Massachusetts received $8 milagain I asked by show of hands lion when its Medicaid program
how many have received these sued Purdue Pharma. I would
letters from Medicaid. This have to think New York
time I counted 6 hands. Folks, Medicaid would be in line for at
let’s be real with ourselves and least $20 million considering
each other. Unlike the radio all the Oxycontin it pays for.
broadcast of “The War of The But then I am trying to insert
Worlds,” this is REALITY! If logic into an illogical system.
in fact you have not received This is just one area the
any of these fines or recoup- Medicaid program can recoup
ment letters, they do exist. Do substantial dollars.
not fool yourself. Those of you
Getting back to the point at
who kept silent at the CE meet- hand, I know you are tired of
ing, SHAME ON YOU!!!! I hearing about it, and believe me
bet you are the same ones who I am tired of writing about it.
complain nothing ever gets But the problem still exists and
done and sits on the sideline it exists now more than ever. I
waiting for others to fight your am extremely frustrated at the
battles! We are in this together. lack of cooperation from many
And by the way, I understand of you who would not even raise
that the “Dead recipient” letters your hands when asked. How
comprised about 100 letters can I anticipate your cooperation
THE PRESIDENT’S REPORT:
NYCPS NEWSLETTER
and support as we move forward? Well, I challenge you to
prove me wrong. When PSSNY
or NYCPS asks for a simple
response to a question, or for
support in body or dollars, rise
to the occasion and get involved.
For those of you who have
been supportive, and we all
know who they are don’t we?
Thank you on behalf of those
who get down and dirty fighting
these battles and even from
those who are too pristine to get
in the ring.
We have many fires to put
out and like the ravaging fires in
California recently they spread
quickly. But also like those in
California, if we put our efforts
together we can rise to the top,
quell the spread, and salvage
what we can and start on a new
road.
Since it is not fair for me to
challenge you without giving
you the opportunity to respond,
here it is:
My
e-mail
is
[email protected]. If you disagree with me, at least be man or
woman enough to let me know.
If you agree with me, then get
involved. Send your financial
support to our Legal War Chest,
call and visit your political representatives, and show up at various functions to fight for your
rights!!!! DO SOMETHING!!
On behalf of your NYCPS
board of directors, we are willing to fight for our rights in
pharmacy but we need your help
and support.
“An Army is a team; lives,
sleeps, eats, fights as a team.
This individual heroic stuff is
a lot of crap” Gen. George
Patton 9
Respectfully,
Jim Detura R.Ph.
President
[email protected]
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 15
LEGAL WAR CHEST UPDATE
For the past four years, The New York City Pharmacists Society has had a Legal War Chest to fund the local battles that we as community pharmacists fight by ourselves day after day. We have fought
various battles including some with PBM’s, and other enemies of community pharmacy. We have educated government officials about the
shortcomings to patients and pharmacies the way PBM’s make payments to pharmacies. We are fighting for our survival. This fund is serperate from the current PSSNY Legal Defense Fund which is being utilized to fund the current PSSNY Medicaid dispute.
As our War Chest grows, we will be enabled to fight the fight
for survival in this dog eat dog health care environment. Thanks to the
generosity of our members this fund continues to grow.
As we see the outrageous PBM contracts, the erosion of our
patients due to mandatory mail order contracts and the reduction of our
levels of reimbursement due to the newly formed Medicare Part D Contracts. At this time more than ever, we truly need a strong professional
voice to fight for our concerns. Please join us in these necessary struggles.
Enclosed is the current list of contributors for the New Year
2007. We will publish past donations as space permits.—the list is done
alphabetically, not in order of receipt or donation amount. (new contributions have an asterisk*)
Thank you Mark Shprinzes of 16th Avenue Pharmacy for
notifying me that you indeed were the person who donated $300 in
early January toward our cause.
J. Schiffer
Final Updated List 2006
David Asencio, Ascencio Pharmacy . . . . . . . . . . . . . . . . . . . . . . .$200
Dominic Amerdolara, Salzman Chemists . . . . . . . . . . . . . . . . . . . .$250
Robert Baker, Thriftway STM Rx . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Robert Baker, Thriftway Classon . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Albert Bluestein Radin Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .$100
Amer Chowdry, Lincon Care Drugs . . . . . . . . . . . . . . . . . . . . . . . .$250
John Demetriades, Farmacon Pharmacy . . . . . . . . . . . . . . . . . . . .$250
Narsinh Desai, Leroy Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .$1,000
Jim DeTura, Melrose Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .$2,500
Jay Dhaduk, Leroy Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . .$500
Keith Diamond, Dermer Pharmacy & Surgical . . . . . . . . . . . . . . .$350
Gloria Fumo, Salzman Chemists . . . . . . . . . . . . . . . . . . . . . . . . . .$250
Roy Eisner, The Charles Pharmacy . . . . . . . . . . . . . . . . . . . . . . . .$200
Steve Gelwan Thriftway Washington . . . . . . . . . . . . . . . . . . . . . . .$300
Howard Goldsmith, Kenby Pharmacy . . . . . . . . . . . . . . . . . . . . . .$150
Paul Hushin, Lakeland Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .$200
Peter Kassel, Kasell Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . .$200
Steve Kaufman, Manhattan Plaza Pharmacy . . . . . . . . . . . . . . . . .$200
John Lam, JW Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$200
Peter Lau, Confucius Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Alan Lee, Mittman Pharmacy* . . . . . . . . . . . . . . . . . . . . . . . . . . . .$250
Long Island Pharmacists Society . . . . . . . . . . . . . . . . . . . . . . . . . .$500
Michael Morelli, Arrow Pharmacy . . . . . . . . . . . . . . . . . . . . . . .$1,000
Sal Pagano, Hartsdale Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .$250
Alex Perchuk, Thriftway SBC Rx . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Alex Perchuk, Thriftway Kings . . . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Stewart Rahr, Kinray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2,500
Nicholas Riccio, Krutick’s Pharmacy . . . . . . . . . . . . . . . . . . . . . .$250
Stuart Rubin, Rafieh Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . .$100
Jim Schiffer, Jim & Phil’s Family Pharmacy Ltd . . . . . . . . . . . . . .$300
Nadira Singh, Thriftway Church . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Lesly Thelemaque, Thriftway Vanderveer . . . . . . . . . . . . . . . . . . .$300
Chandrakant Trevedi, Raan Pharmacy . . . . . . . . . . . . . . . . . . . . .$200
Yan Vilensky, Thriftway Flatbhush . . . . . . . . . . . . . . . . . . . . . . . . .$300
Alex Zatsepilo, Thriftway Foster . . . . . . . . . . . . . . . . . . . . . . . . . .$300
Gilbert Zuckerman, Kenby Pharmacy . . . . . . . . . . . . . . . . . . . . . .$150
Our war chest total to date (2006) . . . . . . . . . . . . . . . . . . . . . .$16,300
List has been updated as of 11/19/07
Purna Aramalla, A Fair Deal Pharmacy . . . . . . . . . . . . . . . . . . . .$500
Michael Agovino, Sedgwick Pharmacy . . . . . . . . . . . . . . . . . . . . .$250
Raymond Bacci, Jim & Phil’s Family Pharmacy . . . . . . . . . . . . . .$100
Robert J. Baker, Thrifway Kings . . . . . . . . . . . . . . . . . . . . . . . . . .$350
James Cannella, Pharmacist at Melrose Pharmacy . . . . . . . . . . .$200.
Charles Ciaccio, Mishkin Pharmacy . . . . . . . . . . . . . . . . . . . . . .$500.
Jim DeFranco, DeFranco Pharmacy . . . . . . . . . . . . . . . . . . . . .$1,000
Jim DeTura, Melrose Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .$5,000
Kieth Diamond, K. Diamond Pharmacy . . . . . . . . . . . . . . . . . . . .$350
Edwige Dorime, Five Star Pharmacy . . . . . . . . . . . . . . . . . . . . . $250
John Duffy, Grove Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$250
Howard Feder, Myrtle Ave Pharmacy . . . . . . . . . . . . . . . . . . . . . .$150
Russell Gellis, Apthorp Pharmacy . . . . . . . . . . . . . . . . . . . . . . .$1,000
Steve Gelwan, Thriftway Washington . . . . . . . . . . . . . . . . . . . . . . .$350
Frank Giordano, Mermaid Pharmacy . . . . . . . . . . . . . . . . . . . . ..$100.
Steve Kaufman, Three S/Manhattan Plaza RX . . . . . . . . . . . . . . . .$500
Robert Nathanson, Congress Pharmacy . . . . . . . . . . . . . . . . . . .$1,000
Alan Lee, Mittman Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$500
Anthony Morano, Friscia Pharmacy . . . . . . . . . . . . . . . . . . . . . . .$100
Mohammed Patel, Oak Park Pharmacy . . . . . . . . . . . . . . . . . . . .$300
Alex Perchuk, Thriftway/SBC Rx . . . . . . . . . . . . . . . . . . . . . . . . . .$350
Alex Perchuk, Thriftway STM . . . . . . . . . . . . . . . . . . . . . . . . . . . .$350
Alex Perchuk, Thriftway STJ RX . . . . . . . . . . . . . . . . . . . . . . . . . .$350
Gene Roberts, Parkway Pharmacy* . . . . . . . . . . . . . . . . . . . . . . .$250.
James Schiffer, Jim & Phil Family Pharmacy* . . . . . . . . . . . . . . .$400
Adam Siegel, Parkway Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . .$250
Nadira Singh, Thriftway Church . . . . . . . . . . . . . . . . . . . . . . . . . .$350
Parthiv Shah, Three P Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . .$1,000
Parthiv Shah, Saldo Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1,000
Parthiv Shah, Fuller Drug Store . . . . . . . . . . . . . . . . . . . . . . . . .$1,000
Mark Shprinzes, 16th Avenue Pharmacy . . . . . . . . . . . . . . . . . . . .$300
Vincent Mazzamuto, Sedgwick Pharmacy . . . . . . . . . . . . . . . . . . .$350
Sam Weinstein, Turtle Bay Chemists . . . . . . . . . . . . . . . . . . . . . .$200
Lesly Thelemaque, Thriftway Vanderveer . . . . . . . . . . . . . . . . . . .$350
Sambasiva Venigalla, Leff Prescription Center . . . . . . . . . . . . .$1,000
Yan Vilensky, Thriftway Flatbush . . . . . . . . . . . . . . . . . . . . . . . . . .$350
John Viscardi, Health Wise Pharmacy* . . . . . . . . . . . . . . . . . . . .$500.
Alex Zatsepilo, Thriftway Foster . . . . . . . . . . . . . . . . . . . . . . . . . .$350
Our war chest total to date (2007) . . . . . . . . . . . . . . . . . . . . . .$21,450
2007 LEGAL WAR CHEST COUPON
The NYCPS Board of Directors appreciates the vote of
Can we count on you to join us in this fight to survive?
confidence from our colleagues, in making these contribu- If you have not already done so, please send in your contritions. Thanks you for this support!
bution with the coupon below.
Yes, count me in; I want to contribute to the New York City Legal War Chest!
Name __________________________________________________________________________________
Pharmacy ___________________________________________________Donation Amount _____________
Address ________________________________________________________________________________
City, State _______________________________________________________________________________
Please send to: NYCPS Legal War Chest c\o Mr. William Scheer • 77 Louis Drive • Farmingdale, NY 11735
PAGE 16 NOVEMBER 2007
NYCPS NEWSLETTER
PSSNY MEDICIAD LAWSUIT UPDATE OCTOBER 31, 2007
Halloween was not a good time for ghosts
nor goblins nor pharmacists working in New
York State. That was because the judge in
Albany County Supreme Court that finally
reviewed and rendered a decision on the PSSNY
Petition against the Office of Medicaid
Inspector General regarding proper use of institutional MMIS numbers served the pharmacy
profession a trick not a treat. Judge Donahue
held that the OMIG did not improperly reinterpret the regulation regarding proper use of
MMIS numbers in submitting claims for prescriptions. Without this decision being overturned by a higher court OMIG is free to continue this harassment of pharmacists throughout
NYS. What is even worse, in audits, OMIG is
using instances of pharmacists using the institutional MMIS number as part of an audit recovery and then to add insult to injury OMIG
extrapolates these findings to add more of a
penalty to pharmacists in their audit summary of
what is allegedly owed to OMIG in overpay-
ments. Therefore PSSNY has decided to appeal
the decision to a higher court. This is an important time for pharmacists in New York State to
be united behind their state organization and
fight this improper interpretation of what pharmacists do all day long in providing care to
patients served by residents and interns in hospital clinics and emergency rooms. If you have
not contributed to the PSSNY legal fund now is
the time to do it. Thank You. 9
Craig Burridge
LEGAL WAR CHEST “SPECIAL MEDICAID FUND” ROUND #2 COLLECTION RESULTS
List has been updated as of 7/15/07
133rd Street Pharmacy, New York......................................$200
Accu Returns, New York .....................................................$100
A.P.K.G. Pharmacy, New York.........................................$1,000
Atluri Pharmacy, Bronx ......................................................$500
Avenue X. Pharmacy, Brooklyn ..........................................$200
Biomed Drug & Surgical, New York ...............................$1,000
Briarwood Pharmacy, Jamaica ..........................................$500
Canarsie Plaza Pharmacy, Brooklyn ...............................$1000
Cannella James, Auburndale..............................................$200
Cash Rx Plus, New York .....................................................$300
City Drug & Surgical/ Amsterd, New York.........................$500
City Drug & Surgical/ Audobon, New York .......................$500
City Drug & Surgical/Heights, New York ..........................$500
City View Pharmacy, Astoria...........................................$1,000
Clinton Apothecary, Brooklyn .........................................$2,000
Colombo’s Pharmacy, Middle Village ................................$500
Columbus Ave. Pharmacy, New York .................................$500
Concord Drug, Briarwood .................................................$500
Congress Pharmacy, Bronx .............................................$1,000
Cropsey Pharmacy, Brooklyn .............................................$200
Dermer Pharmacy & Surgical, Brooklyn ...........................$500
E. Jerome Pharmacy Inc., Bronx.....................................$1,000
Embassy Pharmacy, New York ...........................................$500
Esco Drug Co., New York................................................$1,000
Franco Pharmacy Corp., Jackson Heights .....................$1,000
Firo Inc., Bronx ..................................................................$500
Grace Pharmacy, Elmhurst ................................................$200
Halpern Pharmacy, New York .........................................$1,500
Healthcare Pharmacy, New York........................................$500
J.J. Columbus /Town Drug, New York................................$500
Jim & Phil’s Family Pharmacy, Brooklyn..........................$350
J.J. Pharmacy Co., New York ..........................................$1,000
K&S Pharmacy, Bronx .......................................................$150
Kings Park Slope Pharmacy, Brooklyn ...........................$1,500
Kings Brooklyn Pharmacy, Brooklyn ..............................$1,500
Leroy Pharmacy, Bronx, ..................................................$1,000
Lieb Pharmacy, Brooklyn ...................................................$500
Marlboro Drug Co., Brooklyn ............................................$500
Medcourt Pharmacy Inc., Jackson Heights ...................$2,000,
Melrose Pharmacy, Bronx ...............................................$5,000
Metropolitan Pharmacy, Forest Hills.................................$250
Metropolitan Pharmacy, Richmond Hill ............................$250
Mid Concourse Pharmacy, Bronx ...................................$1,000
MHN RX Melrose, Bronx....................................................$500
Monicas Pharmacy, Brooklyn..........................................$1,500
Myrtle Ave Pharmacy, Ridgewood ..................................$1,000
Neergaard Pharmacy 5th Avenue, Brooklyn ......................$500
Neergard Pharmacy 7th Avenue, Brooklyn ........................$500
Paras Drugs, Brooklyn ....................................................$1,000
Pilgrim Pharmacy, Bronx ................................................$1,000
Raysol Pharmacy, New York............................................$1,000
Rite-Way Pharmacy, Bronx.................................................$500
Rosenblum Pharmacy, Brooklyn.........................................$400
RX-2000 (RX Center), New York .....................................$2,500
S. Bros Pharmacy, Brooklyn...............................................$540
Scarpa Pharmacy, Brooklyn ............................................$2,500
Scheer Drugs, Bronx........................................................$1,000
Sedgwick Pharmacy, Bronx ................................................$750
Shalom Pharmacy, Flushing...............................................$500
Stellas Pharmacy, Brooklyn................................................$250
St Jesus Pharmacy, New York..........................................$1,000
Super Value Drugs, Brooklyn ..........................................$1,000
Thriftway/Church, Brooklyn ...............................................$350
Thriftway/Flatbush, Brooklyn.............................................$350
Thriftway/Foster, Brooklyn .................................................$350
Thriftway/Hosp, Brooklyn...................................................$350
Thriftway/Kings, Brooklyn..................................................$350
Thriftway/SBC, Brooklyn ....................................................$350
Thriftway/Services, Brooklyn..............................................$350
Thriftway/STJ, Brooklyn .....................................................$350
Thriftway/STM, Brooklyn ...................................................$350
Thriftway/Vanderveer, Brooklyn .........................................$350
University Chemists, New York ..........................................$500
University Chemists, New York ..........................................$500
Woodhaven Pharmacy, Woodhaven.................................$1,000
Washington Pharmacy, Bronx.............................................$250
World’s Fair Pharmacy, Flushing ...................................$1,500
Z-Stop Pharmacy, Bronx..................................................$1,000
Total:..............................................................................$60,590
Make checks payable to PSSNY Legal War Chest
“ SPECIAL MEDICAID FUND ”
210 Washington Avenue Extension, Albany, NY 12203
Your Name: _________________________________________________________________________________
Your Pharmacy Name: ________________________________________________________________________
Address: ____________________________________________________________________________________
Telephone : ___________________________________
Amount:
$5,000
$2,500
$1,500
$1,000
Other_____________
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 17
NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 18
PAGE 19 NOVEMBER 2007
News Around the World
From Page 12
Medicare Part D Changes for 2008
There are nearly 2 million low
income patients that must be moved
from one PDP to another PDP
because the existing PDP for 2007
has established rates which are above
the benchmark for the particular
region the patient resides in. Fasten
your seat belts on January 1, 2008 as
it will be another crazy time for Part
D patients. This number is nearly 4
times the amount of patients which
had to be relocated in the last annual
change. Plans like Humana and
United Healthcare have instituted
double digit price increases for 2008
Medicare enrollment period. CCRX
is now known as Community CRX
and they are considered benchmark in
47 of the 50 states, which gives a
presence coast to coast of CCRX.
NYCPS NEWSLETTER
Do you know how these
Prescription Drug Plans get paid by the
government? These plans put together
an annual estimate of their rates,
expenses and revenue. Then after the
year is up, the plan must submit actual
expenses and income to CMS for
review. After all, CMS has guaranteed
these plans will not lose money during
the first two years. However what
nobody predicted was that 90% of the
plans did better financially than they
expected on paper (probably in part
due to the meager, low rates of reimbursement paid to the pharmacies
which were set by the plans). As a
result of this billing formula, the CMS
guidelines are being reviewed at this
time for the 2006 calendar year and
there are 224 plans that owe CMS a
total of $4.37 billion. Wouldn’t it be
nice if NY Medicaid paid us in advance
every month, and then we would submit our actual expenses for operating
three to six months into the next calendar year and if we did better financially than our estimates, we would be
obligated to return the excess payment
without interest to the state by
November of that next year? How
many folks are in debt just running
your operations? What is wrong with
this picture? Why can’t we get the
sweetheart deals the big insurers get?
Folks time to wrap things up.
Black Friday has just passed and I
wonder what recall in the toy business is going to happen next? What is
going on with the imported products,
and even the hamburgers we have
been eating? Thank God the FDA
does not have an open door policy
when it comes to the raw materials
used in drug manufacturing!
Be prepared for a roller coaster of
a New Year! 9
Jim Schiffer
©2007 James R. Schiffer
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NYCPS NEWSLETTER
NOVEMBER 2007 PAGE 20