What: 340B Coalition Winter Conference

Where: The Hotel Del Coronado, San Diego, CA   Booth 23

When: February 29 – March 2

CaptureRx^® built Cumulus^™ to excel with virtually compliant core functionality – without peer. Engineered for compliance, audit and accountable, robust performance across any size network, Cumulus^™  is designed to be the preeminent 340B processing and automation solution.

Experience Cumulus^™ personally in San Diego February 29 – March 2, or anytime online from a CaptureRx^® solutions professional. Our team is here to help you with the 340B program, and what it means for the patient and your enterprise.

Find out more: care@capturerx.com.

The industry is buzzing about audit and compliance; CaptureRx^® confidently offers its capabilities. From national chain pharmacy clients to independent qualifying clinics, Cumulus^™ serves populations better, improves organizations’ bottom lines, and enhances reporting.

CaptureRx^® delivers pharmacy benefits management, 340B, and GPO solutions to America’s hospitals and health centers.

CaptureRx^®, formed in 1999, has been serving community health centers, safety-net clinics and hospitals for more than a decade. Millions of patients have been touched nationwide by CaptureRx^® services to unite patients and community pharmacies, and lowering drug costs through innovative pharmacy benefit management through the use of contracted pharmacy network-based delivery of Public Health Service 340B, GPO and Own Use, and PAP drugs.

CaptureRx^® manages one of the largest 340B programs in the country; operates the nation’s largest 340B contracted pharmacy network, and is a pioneer and technology leader in 340B processing and automation through its proprietary internet “cloud” based platform Cumulus^™.

CaptureRx^® is currently engaged with hundreds of community health centers, hospitals, & managed care programs nationwide.

FQHCs Are Eligible to Become ACOs

This is a great opportunity for Accountable Care Organizations (ACOs) to take advantage of and partner with Covered Entities that are eligible for 340B drug pricing. Although there is a great deal of talk about ACOs, there is still much to be done to put all the pieces together; integrating systems, establishing data warehouses, and creating business intelligence rules to aid in data mining. With that said, some clarifications and changes came in the last week when the final rule was published which differs in seven areas from the proposed rule. The best news was that there were additional groups recognized to both be eligible to form and to participate in an ACO, which are federally qualified health care centers and rural health clinics.

One of the most surprising was that no longer is the electronic health record a condition for participation. Previously 50% of primary care physicians were to be defined as meaningful users by the start of the second performance year. Although this changed, the E.H.R. was retained as a quality measure and is rated higher than other measures for quality scoring purposes. There were also modifications to contacting beneficiaries from quarterly lists to notify them of data sharing and an opportunity to decline which previously only allowed data sharing of claims data for patients seen by ACO primary care physician during the performance year with beneficiaries given the opportunity to decline at POC.

Other areas which changed in the final rule were the start date which allows much more flexibility, aggregate reports-additional reports will be provided unsure what these are yet, assignment process changing from a one step to a two step process and marketing guidelines new file and use which is a less cumbersome process.

Humana and Pfizer announced today a research collaboration focused on improving care for seniors suffering from chronic conditions in primary care settings. The aim is to better understand the needs of those persons 65 years of age and above and develop effective treatments and care to meet their needs effectively and efficiently through collaboration.

These type of collaborations are increasing as we look to ways to employ population health strategies. This targeted group is a subpopulation which continues to increase with the U.S. Census estimating that by 2020 the Medicare-eligible population will reach 65 million – a 36% increase in ten years which consumes a great deal of health care resources making it imperative to look at cost effective approaches to managing chronic disease.

While healthcare policy has been a hot topic of late, one component is consistently overlooked: payment policy.

Because this is a vital component to reform, I wanted to get some thoughts on the subject from an industry expert. I had the privilege to listen to Jack Wennberg, one of the fathers of assessing variation and its impact on costs and quality.

“If healthcare reform reform concentrates on four goals,” Wennberg said, “then the value of care will increase and growth in healthcare costs will decrease.” The goals are as follows: 1) promote organized healthcare delivery; 2) establish informed patient choice around tests, procedures, drugs, elective surgeries and end-of-life care; 3) improve the science of healthcare delivery; and 4) constrain undisciplined growth in spending and capacity.

To accomplish these goals we must understand the questions to ask, the data needed to make assessments, the significance of conclusions reached and the strategies needed to make successful change.

There are some potential hiccups. For example, drug therapy may have potential conflicts among patient preference, administration goals, and clinicians around prescriptions.

For years, hospitals have encouraged generic medications inside hospital walls. However, in outpatient-filled prescriptions, brands produce more revenue. Many patients prefer brand-name medicine, but many experts question patient understanding of generic equivalents.

This issue is an example of a topic where many people may avoid the problem rather than candidly tackle it to understand how to make informed and ethical decisions.

Today we face some of the most significant changes in payment policy, and an increased focus on quality of care to outcome and reimbursement. Those who try to hide from the problems will be out of business; however, those that look critically at how, where and when care is accessed and delivered will be ready to embrace the future.

It is important that we approach the issues directly and transparently share our results so we can better deliver care.

Holly E. Russo, RN, MSN, MS, ECS
Vice President Hospitals and Health Systems, Chief Clinical Officer
holly.russo@capturerx.com

Last month, the Government Accountability Office issued a critical report on the 340B program. GAO interviewed 61 stakeholders in the program about their ability to generate revenue and distribute drugs. GAO also examined the adequacy of federal oversight of the program.

The main thrust of the report is that 340B needs better federal oversight, identifies areas of the program that need clarification and warrant discussion. But the government should not act upon the findings because the review was flawed and undermined by sampling bias and size.

My first takeaway from the report is that existing technological solutions would simultaneously provide transparency within the 340B program and ensure adherence to it. These technologies can help entities make informed decisions while reassuring the government that the industry is meeting standards.

The report raises questions about how two organizations utilize the program. Unfortunately, GAO never specifically cites an example of 340B being abused; it just insinuates problems in a prescriber area that causes much confusion, with some entities interpreting it too narrowly and others too broadly. The government could alleviate this concern by clarifying its intent.

GAO also raises concerns about access of covered entities for certain drugs caused by drug shortages, but the agency offers no real strategies to address this issue.

Despite a small sample size and a bias in interviewee selections, the report makes some valid observations. Many covered entities are using revenue gained through the 340B program to either provide access to services, increase services available, subsidize care for the uninsured or just simply keep their doors open.

However, only 13 of the 20 entities interviewed — or roughly 60 percent — are generating revenue. That does not fairly represent participants in the program.

GAO falls short of actually saying there is a real problem with diversion, duplication, discounting and overcharging by manufacturers. Rather, it makes rash generalizations without sufficient data to support the claims.

Programs like 340B are not perfect, but they provide an important service to our under-insured and uninsured citizens. I hope that future GAO studies will include larger sample sizes and will not operate under the impression that the program is inherently flawed.

The health sector represents approximately 18% of the US economy, of this sector hospitals are the largest component. Today, hospitals are looking forward to cuts in reimbursement, changing attitudes toward quality of care, increased focus on readmissions and unnecessary admissions, health reform and new reimbursement models emerging such as Accountable Care Organizations and accountability for outcomes (clinical, satisfaction with care, financial).

Under the Budget Control Act of 2011, if either the Joint Select Committee on Deficit Reduction is unable to come up with required level of budgets cuts, or Congress fails to approve the recommendations of the committee, the Medicare program would be subject to a sequester of up to 2 percent, which according to a report by Tripp Umbach on the Negative Economic Impact of Cuts to Hospital Funding ,the projected cut top hospitals is approximately $41 billion from 2013 to 2021 (TrippUmbach, 2011). This means possible hospital closures, decreases in employees, and other cuts which can impact availability of care as well as the quality of care there are able to provide.

For years the connection between costs and quality of care have been overlooked for the most part, even though numerous studies indicate that spending more does not necessary lead to better outcomes. There is a growing belief that the key to improving health care while controlling costs is making clinicians and health care organizations accountable for care rendered which is the basis for the premise behind Accountable Care Organizations and Health Reform in the United States. With this said, we are seeing and will continue to see changes to the ways clinicians and health care organizations are reimbursed, increased accountability for outcomes and these tied to payment, as well as more transparency around patient care with the increase in use of information technology tools. We are also in the most significant debt crisis our country has ever seen, rising unemployment, Increasing numbers of persons on Medicaid, and people living longer with Medicare benefits. What is worrisome – will health care organizations be able to provide the quality of care desired with the significance of reductions in reimbursement to these organizations and will other insurers follow Medicare’s lead.

In summary, we all have a lot on our plate in the future but what is increasingly clear is one has to think out of the box, look into the ways information is tied together, how and where care is delivered and how data can be integrated and mined to look at trends and areas for improvement, as well as ways to save money and increase revenue. The PHS 340B Program not only allows a covered entity to save money on administered medications, obtain revenue on eligible prescriptions filled in retail contracted pharmacies, but through companies such as CaptureRx, these entities can also use this data to assist in measuring persistency/adherence, trends in prescribing among clinicians, measuring whether practice guidelines are being utilized, and by combining information from reporting on prescriptions filled with information on biomarkers, and other indicators to measure outcomes. The organizations that remain in the future will be visionary as well as savvy in piecing together programs which avail them of opportunities to improve their bottom line.

September 26-28, 2011 – CaptureRx® will be hosting our “Uncorked & Unplugged” evening event on Monday, September 26th at 7:30pm, during the 2011 Fall Hospital Pharmacy Conference at the Arizona Biltmore Hotel & Resort in Phoenix, AZ. Come by villa #7222 – meet with 340B experts, wine tasting, live music, hors d’oeuvres, and prizes. This conference will have up to (225) Hospital Pharmacy Directors and GPO Pharmacy Executives will Man & Host Exhibit Booths as a Reverse Expo.

About Reverse Expo
Hospital Pharmacy Executives will host & man the Exhibit Booths while the Vendors, Suppliers and Manufacturers will walk the trade room floor visiting each Hospital and Health System booth to dialogue with the Hospital Pharmacy Executives about their products & solutions. We find this to be a much more cost effective and time effective way to insure that the Suppliers get to meet as many Hospital decision makers than they normally would in a traditional trade show format. Our Conference is built around providing the optimum environment for building relationships with Hospital Executives. As an attendee at this Conference you will have the opportunity to share meals, educational sessions, the REVERSE EXPO and networking receptions with the top Hospital & Health System Pharmacy Executives in the United States today, all under the same roof for over (2) two days. No other Conference in America offers Vendors more face-to-face and networking time with Hospital Pharmacy Directors than this Conference.

Visit the CaptureRx® exhibit booths to learn how CaptureRx® can bring 340B, GPO and Own Use automation to hospitals’ expanding contract pharmacy opportunities. CaptureRx® will also inform your of our new proprietary Cumulus™ Platform is an advanced cloud computing architecture deployed over the internet to collect and capture 100% of all prescription claim transactions across multiple pharmacies and multiple payers in real-time at the switch service level.

For more information on the Conference, visit, 2011 Fall Hospital Pharmacy Conference Website. For information regarding CaptureRx®, Contact us today.

Eric Yonkus, Nathan White, Holly Russo, and Ed Gilmartin

San Antonio, Texas, Aug. 9, 2011 — Former Congressman and PhRMA CEO Billy Tauzin has joined the board of the pharmaceutical benefits management company CaptureRx. He will also serve as the company’s Chief Industry Relations Officer.

Tauzin will work on behalf of CaptureRx, its hospital and health-center clients, and the national pharmacy networks that partner with the company. He will add his voice to initiatives that include identifying best practices and standardization of processes and reporting, and building relationships with managed care and federal and state agencies.

“Both clients of CaptureRx, a valued corporate member of our association, and the entire 340B community will be lifted by having someone of Mr. Tauzin’s stature in our corner,” said William von Oehsen, president of the Safety-net Hospitals for Pharmaceutical Access, the 340B trade association that represents more than 600 university and nonprofit hospital systems.

In 2004, Tauzin was diagnosed with a rare form of intestinal cancer. “I was given less than a 1 percent chance of survival, but thanks to innovative drug therapies, I overcame the odds,” he said. “I see my new role with CaptureRx as an opportunity to increase the access that underinsured folks have to these life-saving pharmaceuticals,” said Tauzin, who served as Chief Executive Officer of the Pharmaceutical Research and Manufacturers for 5-1/2 years after leaving Congress.

Based in San Antonio, Texas, CaptureRx is a leader in administering a federal drug program called 340B, which lowers the cost of health care at zero cost to the government. Under the program, qualified hospitals and health centers purchase drugs for the program’s patients at half the cost — even less than Canadian drug prices.

This creates a safety net for much of the nation’s under-insured and uninsured in an environment of looming federal deficits. The pharmaceutical industry provides the nearly $7 billion in annual funding for 340B via special pricing under federal regulation.

As CEO of PhRMA, Tauzin helped create the Partnership for Prescription Assistance (PPA), which provides free medicines to more than 6 million Americans who otherwise couldn’t afford them. He will continue that push at CaptureRx by maintaining an open dialogue with drug manufacturers on compliance with the 340B program and the need to protect it.

ABOUT CAPTURE RX

CaptureRx manages one of the largest 340B programs in the country and operates the nation’s largest 340B contracted pharmacy network. The company is a pioneer and technology leader in 340B processing and automation through its “cloud” based platform called Cumulus. For more information go to www.capturerx.com, or call 888-345-6424.

July 11-13, 2011 – CaptureRx® will be exhibiting at the 15th Annual 340B Coalition Conference at the Omni Shoreham Hotel, Washington D.C. The 15th Annual 340B Coalition Conference is the premier venue to examine how 340B stakeholders can prepare themselves for this new environment. It is also the place to find out the next steps that 340B advocates and detractors will be taking to reform the program. Visit the CaptureRx® exhibit booths to learn how CaptureRx® can bring 340B, GPO and Own Use automation to hospitals’ expanding contract pharmacy opportunities. CaptureRx® will also unveil it’s new proprietary Cumulus™ Platform is an advanced cloud computing architecture deployed over the Internet to collect and capture 100% of all prescription claim transactions across multiple pharmacies and multiple payers in real-time at the switch service level. For more information on the Conference, visit, 15th Annual 340B Coalition Conference Website. For information regarding CaptureRx®, Contact us or request a free web demo.