News in brief - June 21, 2004

CMS creates EMTALA advisory group - Wis. sues drugmakers over pricing - Medicaid access to specialists is low - Reimport request denied

CMS creates EMTALA advisory group

The Centers for Medicare & Medicaid Services announced the formation of a technical advisory group to review regulations affecting hospital and physician responsibilities under the Emergency Medical Treatment and Active Labor Act.

The panel is charged with helping the agency devise rules to protect patient rights while minimizing the burden on hospitals and physicians.

"Last year, the department took an important first step by clarifying and simplifying our EMTALA regulations to protect patient rights and give clear guidance to providers," said CMS Administrator Mark McClellan, MD, PhD. "I have every expectation that this advisory group will have additional ideas for us to further improve the regulations."

The committee will consist of 19 members, including seven practicing physicians from emergency medicine, cardiology or cardiothoracic surgery, orthopedic surgery, neurosurgery, pediatrics or a pediatric subspecialty, obstetrics-gynecology and psychiatry. The committee will meet in late fall.

Wis. sues drugmakers over pricing

Wisconsin has joined other states in taking the nation's largest pharmaceutical manufacturers to court over the way they price their products. Wisconsin Attorney General Peg Lautenschlager June 3 filed a lawsuit against 20 manufacturers accusing them of publishing false average wholesale prices.

"The complaint alleges that the drug companies know that when they publish false average wholesale prices for their drugs they cause the state of Wisconsin, its citizens and its health care organizations to grossly overpay for prescription drugs," Lautenschlager said in a statement.

The lawsuit asks for reimbursement for state programs, such as Medicaid; Medicare recipients, who pay 20% of drugs costs when Medicare covers the prescription; and private citizens who pay for prescriptions.

Medicaid access to specialists is low

Getting an appointment with a specialist can be hard for Medicaid patients, according to a recent survey by Merritt, Hawkins & Associates.

The survey of 1,062 physicians' offices in 15 metropolitan areas found that 50% of cardiologists' and 60% of obstetrician-gynecologists' practices accept Medicaid patients, and 43% of dermatologists and 44% of orthopedists take these patients.

But there was wide variation both across and within the cities. For example, all of the specialists called in Portland, Ore., accepted Medicaid, whereas only a handful in New York said they would accept it.

The survey also showed privately insured patients can experience long waits for specialist appointments.

Reimport request denied

The Food and Drug Administration has denied a request by Illinois Gov. Rod Blagojevich to set up a pilot program for reimporting drugs from Canada.

The proposed program would have allowed the state to save an estimated $56.5 million on prescriptions through contracting with a Canadian pharmacy benefits manager or through the state acting as a bulk purchaser. The program have would been limited to 230,000 state employees and retirees and to drugs agreed upon by the state and the federal government.

The FDA indicated in a letter to the governor that the proposal could not be authorized under current law and presented added safety concerns.

In a separate letter, Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, encouraged Blagojevich to consider a multistate Medicaid drug purchasing pool, like the one recently authorized by his agency.