DME MACs to Retire Pneumatic Compression Device LCDs in November
The DME MACs will retire the local coverage determinations (LCDs) for pneumatic compression devices for claims with dates of service on or after Nov. 14, 2024.
In an Oct. 3 news announcement, CGS Administrators, the Jurisdictions B and C DME MAC, said the Medicare contractors decided to retire the LCDs “due to existence of National Coverage Determination [NCD] 280.6.”
NCD info can be found in the Medicare National Coverage Determinations Manual, chapter 1, section 280.6. Additional coding and billing information can also be found on the CGS website.
NCPA Applauds FTC Lawsuit Against PBMs
The National Community Pharmacists Association (NCPA) has praised a new Federal Trade Commission (FTC) lawsuit against the three largest pharmacy benefit managers (PBMs) in the United States.
In a Sept. 20 press release, the FTC said it had filed suit against Caremark Rx, Express Scripts, and Optum Rx “for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list-price products, and shifted the cost of high insulin list prices to vulnerable patients.”
The FTC’s administrative complaint contends that the PBMs “have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for their life-saving medication.”
The three PBMs in total administer about 80% of all prescriptions in the country.
NCPA CEO B. Douglas Hoey said in response to the lawsuit, “One of the many ways that PBMs manipulate the system against patients, taxpayers, and small pharmacies is the rebate game. The PBMs determine which drugs are covered by health insurance plans. They get bigger rebates for the most expensive drugs. Naturally, the most expensive drugs end up on the formularies, even when there are cheaper alternatives.
“Patients end up paying more. Employers end up paying more. Taxpayers end up paying more. And more small business pharmacies are driven out of business. The rebates create a powerful incentive for higher drug prices, which is completely upside down. We are very pleased that the FTC is seeking to end that practice.”
