(Washington, DC) - In an unprecedented joint effort, America's Health Insurance Plans (AHIP), the National Community Pharmacists Association (NCPA), and the National Association of Chain Drug Stores (NACDS) have collaborated to simplify and standardize the steps that most affect service for Medicare beneficiaries filling prescriptions at pharmacies.

NACDS, NCPA, and AHIP have worked together over the past six weeks, along with the American Pharmacists Association (APhA) and the Pharmaceutical Care Management Association, to simplify and standardize the electronic claims processing messages going from Medicare Part D drug sponsors to independent pharmacies and retail chains. The initial step in this effort was to provide pharmacists electronic message clarity regarding the coverage status of certain drugs.

Coverage denials can be grouped into two categories: drugs that are denied because they are excluded from Part D coverage as mandated by the Medicare Modernization Act, and drugs that are denied because they are covered under Medicare Part B.

AHIP, NACDS, and NCPA developed and presented joint recommendations to a Work Group of the National Council for Prescription Drug Programs (NCPDP), the organization that creates and promotes standards for transferring data to and from pharmacies. NCPDP has approved a process for using standardized coding and electronic messages notifying pharmacists of claims rejections in these two situations.

Today, NACDS, AHIP, and NCPA are transmitting to the Centers for Medicare & Medicaid Services (CMS) and NCPDP a second set of recommendations to further improve service to Medicare beneficiaries filling prescriptions at community pharmacies. The new proposal for additional standardized electronic claims processing messages to pharmacists addresses prior authorization requirements, daily dose limitations, quantities that may be dispensed for a given prescription, and age and gender contraindications.

"The result of the work between our groups is that everyone wins," said Bob Hannan, Interim CEO of NACDS. "Medicare recipients will benefit from this important collaboration through less confusion, less time at the pharmacy counter, and faster access to the medications they need. Pharmacists will also be assisted through improved communication concerning the status of drugs covered under Medicare."

The success of this unprecedented collaboration among AHIP, NCPA, and NACDS has led to discussions of how to build on these cooperative efforts.

"I think we have a unique opportunity to build on this collaboration between prescription drug plans and pharmacists to identify additional efforts to improve the Medicare Part D benefit and build a new model that results in enhanced patient care," said NCPA Executive Vice President and CEO Bruce Roberts, RPh.

At a news briefing today, CMS Administrator Mark B. McClellan, MD, PhD, also announced the formation of the Pharmacy Quality Alliance (PQA). PQA will aim to improve pharmacy care and outcomes through a collaboration of the pharmacy community, health plans, government, employers, physicians, and consumers. The goal of PQA will be to agree on a strategy for measuring and reporting data that will help consumers make informed choices and appropriate healthcare decisions.

"Pharmacists and pharmacies have demonstrated how important they are to the implementation of the Medicare drug benefit, and we're pleased to support these collaborative efforts," said Dr. McClellan. "The PQA is an important next step in supporting pharmacists' efforts to improve quality and reduce costs in our health care system," he said.

The founding members of PQA will include APhA, NACDS, NCPA, and AHIP along with other leading consumer groups, pharmacy organizations, employer groups, physician organizations, and health plans.

"Today's health care challenges require that we as stakeholders roll up our sleeves, remove ourselves from silos, and work together with new partners and in new ways," said AHIP President and CEO Karen Ignagni. "No one stakeholder alone can achieve the system-wide improvements in quality that we hope to achieve together," she said.

The National Community Pharmacists Association, founded in 1898, represents the nation's community pharmacists, including the owners of more than 24,000 pharmacies. The nation's independent pharmacies, independent pharmacy franchises, and independent chains represent an $84 billion marketplace, dispensing nearly half of the nation's retail prescription medicines.

The National Association of Chain Drug Stores (NACDS) represents the nation's leading retail chain pharmacies and suppliers, helping them better meet the changing needs of their patients and customers. Chain pharmacies operate more than 37,000 pharmacies, employ 114,000 pharmacists, fill more than 2.3 billion prescriptions yearly, and have annual sales of nearly $700 billion. Other members include more than 1,000 suppliers of products and services to the chain drug industry. NACDS international membership has grown to include 93 members from 30 countries. For more information about NACDS, visit www.nacds.org

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