Pharmacists, Drug Wholesalers Offer Solutions to Avoid Disruption for Medicare Beneficiaries

This press release is an announcement submitted by American Pharmacists Association, and was not written by Diabetes Health.

Certain Medications Commonly Used to Treat High Blood Pressure, Diabetes, Depression and Other Conditions May Not be Covered in 2010

Dec 3, 2009

ALEXANDRIA, Va. (Dec. 1, 2009) - Seniors may find that many common prescription drugs that Medicare Part D has covered for years may suddenly be denied due to a new policy being implemented by the Centers for Medicare and Medicaid Services (CMS).

To minimize disruption on patients and pharmacies, the American Pharmacists Association (APhA), Food Marketing Institute (FMI), Healthcare Distribution Management Association (HDMA), National Association of Chain Drug Stores (NACDS), and National Community Pharmacists Association (NCPA) have written a letter to CMS Acting Administrator Charlene Frizzera, outlining concerns and potential remedies, and urging the agency to continue its outreach to stakeholders.

Starting Jan. 1, CMS is scheduled to begin enforcing its non-matched National Drug Code (NDC) list policy. At that time any medication not appropriately registered with the Food and Drug Administration (FDA) will no longer be covered under Part D. With this deadline fast approaching, thousands of products are currently included on the non-matched NDC list and, thus, scheduled to be denied by Medicare Part D plans in a few weeks. These include many common prescription products seniors rely on, such as antidepressants, antibiotics, pain relievers, and blood pressure and diabetes medicines. (Many drugs have multiple NDCs to reflect the varying strengths, quantities and packaging by which they are sold. However, some drugs may still be covered, but only for the NDCs listed.)

"We strongly encourage you to continue outreach to manufacturers whose products are on the non-matched list as well as Part D plans," the groups wrote. "We also strongly urge CMS to consider holding an open door forum as soon as possible in order to capture concerns of all interested stakeholders. Although we have communicated with our respective supply chain partners, ultimately, the manufacturer bears the responsibility to register their products appropriately with the FDA and with Part D plans to ensure their formularies and edits reflect CMS policies in a timely fashion."

The groups' other concerns include: 

  • Patient Disruption- Patients may be denied medication they have obtained under Part D for years.The coalition recommends a standard CMS fact sheet or similar document, available online, to help pharmacists answer beneficiaries' questions.
  • Supply Chain Concerns- Denying access to one generic drug will likely increase demand for equivalent generics, of which sufficient supply may not be readily available. Such supply chain issues further endanger beneficiary access.
  • Inconsistent Implementation by Part D Plans- Some Part D plans may employ point-of-sale (POS) edits at the pharmacy level to block dispensing of unlisted drugs, but others may not, frustrating patients and pharmacists alike. To promote consistency in implementation, the coalition recommends that CMS either update the CMS non-matched NDC list on a more frequent basis or require plans to utilize the FDA's NDC list to keep POS edits current.
  • Retroactive Reversal of Claims- The coalition urges CMS to prohibit retroactive reversal of approved claims for NDCs that appear on the non-matched list.These claim reversals would be unfair to pharmacies that dispensed the medications pursuant to plans' approval of claims at the point of sale.

The groups have also urged brand and generic drug manufacturers to step up their efforts to ensure their products' NDCs are registered with the FDA, as evidenced by a Nov. 17 letter from NCPA to their trade associations. 

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Categories: Diabetes, Diabetes, Food, Health Insurance, Medications, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 6 December 2009

This sounds like an absolute disaster. Where can we find more information about this policy, who can we write or call about changing it, and where can we see the actual list?

Posted by Pauline Barrett on 8 December 2009

Where is the citation to back up these threats? What drugs are on the list? Scaring us with no suggested plan of action is not helpful to us who participate in regular lobbying activities.

Pauline Barrett,
American Association of University Women
Seattle, WA

Posted by Anonymous on 9 December 2009

Your warning doesn't do us much good without specific steps to take. For example, how can I check on my specific medications? I actually found the list you mention but it consists entirely of numbers which is useless. If you just give out the number of any one of the offices involved in this we could flood them with e-mails, calls, and questions. As it is, I will be calling my Senator and Representative just as a place to start. I recommend others do the same. The sad thing is when I have called them before they have been woefully ignorant of many key issues and unwilling or unable to research them.

Posted by Anonymous on 9 December 2009

After a little poking around on Google I found an FDA site that lets you enter the name of a medication and then shows you if it's on the list or not. Here's the link. You can copy and paste into your browser. You may have to copy in two parts if it doesn't work at first.

They may be updating on an ongoing basis so if your medication is not there, you could call the main FDA number and asking about your medication. Enough phone calls and hopefully they'll get moving a little faster on straightening this thing out. Here's their main number: 1-888-INFO-FDA (1-888-463-6332).

Posted by Anonymous on 9 December 2009

visit for more information on covered medications

Posted by Anonymous on 9 December 2009

Here is another site from the FDA which lets you look up to see if your drugs are on this list by Proprietary Name, Active Ingredient, and Firm name. The page says these lists are current through November 30 so if you don't find your drug it may have been added since then but I would definately follow up if you don't find it.

Posted by Anonymous on 25 December 2009

Why aren't the organizations, such as the American Diabetes Assoc, who write me asking for money, writing me about this issue and setting up petitions to send to our Congresspeople? AARP has stood firm for closing the donut hole, what good if my meds are not on appoved lists? We senior diabetics struggle enough with the cost of medicine, doesn't the FDA have any touch with the real world? I am in the donut hole, already paying high retail prices, I simply could not spend more, I don't have it and I am in debt up to the max of my cards. I would have to dance with death because I would not be able to buy my meds. HELP!

Helen Mueller

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