Texas Letter [RE: Proposed Medicaid Fee-For-Service Payment Rates for Pharmaceutical Providers]
November 22, 2015
VIA EMAIL & Hand-delivery
Senior Policy Analyst
Vendor Drug Program
Health and Human Services Commission
85200, Mail Code 2250
Austin, TX 78708-5200
RE: Proposed Medicaid Fee-For-Service Payment Rates for Pharmaceutical Providers
Dear Ms. Johnston:
The State Patient Access Coalition appreciates the opportunity to provide comments on the Texas Health and Human Services Commission (HHSC) proposed Medicaid fee-for-service payment rates for pharmaceutical providers contained in the Proposed Rules Section of the Texas Register from October 30, 2015. Although the proposed rules address a wide range of issues, this comment letter focuses on the proposed change from estimated acquisition cost (EAC) to specialty pharmacy acquisition cost (SPAC) for drug ingredient reimbursement and the switch from a “provider’s dispensing fee” to a “professional dispensing fee.” Given the unique requirements of dispensing blood clotting factor, The State Patient Access Coalition would respectfully request that HHSC consider using this rulemaking process to promulgate a unique Medicaid reimbursement for blood clotting factor that takes into account the extensive efforts required to provide blood clotting factor to Medicaid recipients. We would also request language in the final SPAC rule that would ensure Medicaid reimbursements represent the current market value of blood clotting factors.
- Maintain a product inventory to provide the full range of available blood clotting factors, including all available assays and vial sizes;
- Provide all necessary ancillary supplies for administration of blood clotting factor including needles, syringes, and sterile gloves;
- Provide containers for the disposal of hazardous waste, and the collection of such containers shall be arranged pursuant to state and federal law;
- Fill all prescription orders within 48 hours and all emergency orders within 12 hours;
- All prescription orders must be within plus or minus 5-10 % of prescribed assays;
- 24 hour on call support by nurses, pharmacists, multilingual interpreters and support staff trained in bleeding disorders;
- Case management services to evaluate and promote adherence to variable and, at times, complex dosing guidelines;
Unique delivery requirements including temperature controlled shipments with proof of delivery;
Notify patients of product recalls and withdrawals; and
Provide medically necessary nursing services, including the administration of clotting factor therapies.
|Dispenses to Medicaid Patients||Weighted Average||Median|
|Total Direct Costs per Dispense||$385.82||$359.53|
|Total Indirect Costs per Dispense||$612.37||$1,409.82|
|Total Costs per Dispense**||$998.19||$1,723.34|
HHSC could ensure it meets its mission of providing “the highest standards of customer service” if the proposed rule is finalized in a way that recognizes the professional efforts performed by specialty pharmacies dispensing blood clotting factor to Texans with rare, chronic conditions such as hemophilia. As is outlined above, dispensing blood clotting factor requires enhanced services and activities that vary greatly from those performed by a typical retail pharmacy. In many cases, these services are unique even in comparison to other products sold by a specialty pharmacy. In recognition of these unique services, the State Patient Access Coalition would respectfully request that HHSC consider using this rulemaking process to promulgate a unique Medicaid reimbursement for blood clotting factor that takes into account the extensive efforts required to provide blood clotting factor to Medicaid recipients.
2 Dobson DaVanzo & Associates is a well respected health economics and policy consulting firm based in Washington, DC, whose work has influenced the design of demonstrations and many public policy decisions, and appears in numerous instances in legislation and regulation.
3 42 CFR 447.502
4 Averages are weighted by number of dispenses. **5th Percentile, Weighted Average, Media, and 95th Percentile determined independently for each row using source data, therefore one cannot sum or re-calculate statistics using the data provided across rows to derive totals. 5th and 95th percentile are derived.
5 Evaluating Blood Clotting Factor Dispensing Cost for Medicaid Beneficiaries; Dobson DaVanzo & Associates (2014).