1. Triplicate Supply Exhausted Earlier than Expected;
    Some Pre-July 1 Orders Cannot Be Filled
The state exhausted its supply of triplicate prescriptions earlier than anticipated and was unable to fill some orders received before the July 1 deadline, state officials told CMA on Friday. Physicians who run out of triplicates will be able to use an “emergency-fill” exemption to write prescriptions for controlled substances, state officials announced at a meeting in Sacramento.

Additionally, orders of 300 or more triplicates were trimmed to stretch the supply. Physicians whose orders could not be filled should already have been notified by the state Department of Justice (DOJ).

The shortage was caused by an unanticipated increase in physician orders in the days before the July 1 ordering deadline for triplicates, which are being phased out of use during the next six months. This announcement was made during a meeting hosted by CMA and attended by officials of DOJ, the California Board of Pharmacy, the California Narcotic Officers’ Association, the Compassion in Dying Federation, and others.

The meeting is one in a series of sessions to discuss the state’s new tamper-resistant prescription forms, which are being phased in for prescribing controlled substances. Both the new forms and the current triplicate forms may be used throughout 2004. Beginning January 1, all prescriptions for controlled substances (Schedules II-V) must be written on the new, secure prescription forms.

DOJ recommends that affected physicians invoke the emergency prescription statute (Health and Safety Code §11167), which permits the use of regular, nonsecure prescription forms for Schedule II prescriptions in “an emergency where failure to issue a prescription may result in the loss of life or intense suffering.” To do this, physicians simply write “11167” on the regular prescription form and submit it to a pharmacy.

Although section 11167 requires physicians to follow-up by submitting a triplicate or tamper-resistant form to the pharmacist within 7 days of the initial prescription, DOJ and the pharmacy board recognize that because of the lack of proper prescription forms that may be impossible for some physicians. As a result, enforcement of the 7-day rule will be a low priority during the transition period, according to officials with DOJ and the pharmacy board.

“DOJ will not pursue enforcement efforts against these physicians who have documented their situation, including their attempts to order the appropriate forms. DOJ will not investigate physicians for this technical noncompliance until it is clear to our staff that physicians can fully comply with the law,” said Alberto Gonzales, special assistant attorney general with DOJ.

Patricia Harris, executive officer for the California Board of Pharmacy, agreed, saying “the Board of Pharmacy is interested in whether the prescription is valid and whether the patient is being adequately treated.”

DOJ does not have the statutory authority or funding to print and/or distribute additional triplicates after the July 1 deadline, said Gonzales. As a result, CMA may pursue fast-track legislation that would allow DOJ to print more triplicates and make it more straightforward if physicians must utilize the “emergency fill” exemption, which is currently allowed under Health and Safety Code Section 11167.

Remember, physicians are still allowed under Health and Safety Code Section 11159.2 to issue prescriptions for Schedule II drugs on regular prescription pads for terminally ill patients. Triplicate or tamper-resistant prescription forms are not required for terminally ill patients who are certified by a physician as 1) suffering from a incurable, irreversible, illness; 2) expected to die within one year; and 3) receiving the Schedule II prescription for symptom management and not cure. The words “11159.2 exemption,” however, must appear on the prescription form.

CMA continues to work with state officials and others to ensure the transition from triplicates to the new tamper-resistant forms is as easy and inexpensive as possible.

Click here for more information, including the new record keeping requirements for physicians who dispense schedule II drugs.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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2. Proposed Regulations Would Cut Medicare
Payments for Cancer Drugs by as Much as 89 Percent
The Centers for Medicare and Medicaid Services (CMS) on Tuesday issued proposed regulations that would cut oncologists’ Medicare reimbursement for drug therapies an average of 8 percent next year. Payments for some cancer drugs, however, would be reduced by as much as 89 percent.

The proposed regulations are part of last year’s Medicare prescription drug law, which included an overhaul of how Medicare pays for physician-administered injectable drugs, such as chemotherapy.

The proposal cuts reimbursements to oncologists and other physicians for injectable drugs, but fails to account for the true cost of providing cancer patients with specialized outpatient care, such as counseling on nutrition, physical therapy, and cosmetics, including wigs and make-up. CMA leaders believe such cuts will seriously jeopardize outpatient care for patients with cancer.

“These cuts would have a severely detrimental effect on outpatient cancer treatment in California,” said CMA CEO Jack Lewin, M.D. “The payments will not in many instances even cover physicians’ costs and could force some oncologists to stop providing outpatient cancer care to Medicare patients.”

If doctors find it is too expensive to provide chemotherapy in their offices, they will send patients to hospitals, which is far more expensive and less convenient for patients.

CMA’s goal is to maintain drug and practice expense reimbursement rates at the 2004 level as an interim step until a long-term solution can be reached through new legislation or a change in the regulations. This will allow time for completion of the Medicare Payment Advisory Commission (MedPAC) study, which will clarify the potential impact of the new Medicare law on access to cancer care for Medicare beneficiaries.

CMS is accepting comments on its proposed regulations until Sept. 24.

Click here for more information.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.

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3. Health Care Largely Spared in '04-'05 Budget
The month-long legislative standoff over the California state budget neared its end this week as legislative leaders reached a tentative agreement with Governor Schwarzenegger. The $105 billion spending plan does not cut physician reimbursements and contains and far fewer cuts to health and welfare programs than had originally been proposed in the governor’s January budget proposal.

The agreement also rolls back a portion of the Davis Administration’s 5 percent Medi-Cal cut. (The roll back affects groups not protected by the preliminary injunction CMA won last year in federal court.)

The Assembly late last night passed the budget by a vote of 69 to 11. The spending plan now goes to the Senate for their approval. CMA will publish a special Budget Watch Alert when the budget is signed by the governor.

Click here for more information.

Contact: Heather Campbell, 915/444-5532 or hcampbell@cmanet.org.

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4. Physicians, Beware of Scam Involving Phony Medicare Employees
NHIC, California’s Medicare carrier, recently asked CMA to alert members to a Medicare scam currently targeting Southern California physicians. NHIC has learned that individuals impersonating NHIC or Medicare employees have been contacting physician offices and attempting to obtain information about physicians and their businesses. This may be an attempt to steal physicians’ professional identities or compromise patients’ privacy.

Physicians may receive legitimate calls from NHIC requesting information. If there are any questions or concerns about the person requesting that information, you should:

1. Ask for the inquirer’s telephone number (but not their direct line), and call back to confirm their identity. If they give you a badge number, be aware that NHIC employees do not have badges.
2. Obtain the control number for the information being requested, and call NHIC to verify the request. (In Northern California, call 877/591-1587; Southern California, 866/502-9054.)
3. If the request is in writing, make sure it is on a letterhead. Compare the letterhead to previous communications that you have received from NHIC.

Report any suspicious inquiries by calling the U.S. Office of the Attorney General’s fraud hot line, 800/HHS-TIPS.

Contact: Frank Navarro, 916/444-5532 or fnavarro@cmanet.org.

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5. TRICARE Physicians Should Sign New Contracts by Tomorrow, July 30
Physicians who treat TRICARE enrollees should be aware that effective July 1, Blue Shield of California replaced HealthNet as TRICARE’s subcontractor. The TRICARE health care plan provides health coverage for more than 6 million military personnel and their families.

In order to continue seeing TRICARE patients, physicians need to sign a new TRICARE/Blue Shield contract. If you have not already signed a new contract—and you wish to continue seeing your TRICARE patients on an in-network basis—please call TRICARE/Blue Shield (866/296-8744) immediately and request a contract. To ensure your TRICARE participation is not interrupted, contracts received by July 30 will be retroactive to July 1.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.

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6. Medical Students: Represent Your Peers as AMA Regional Delegate
CMA invites medical student members to nominate themselves to represent their peers as a Region I delegate to the AMA House of Delegates. Serving as a delegate is an invaluable experience that allows participants to play a role in the development of AMA policy.

Nominees must be CMA, AMA, and county medical society members; have served on CMA’s Medical Student Section Governing Council (or show other relevant experience); and have attended a previous national AMA medical student meeting.

Download an application online and return the completed form (signed by your medical school dean) along with a letter of intent and a copy of your CV to Tina Nabong at CMA no later than August 27.

Region 1 covers 15 western states, including California. Region I representation elections will be held in December.

Contact: Tina Nabong, 916/551-2073 or tnabong@cmanet.org.

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7. CMA Seeks Feedback on California Physicians Legal Handbook
CMA’s Center for Legal Affairs publishes the annual California Physicians Legal Handbook (CPLH) to answer the legal questions most frequently asked by physicians. To continue to provide you with the most useful legal guide for your practice, we need your help.

Please click here by August 31 to fill out the CPLH survey. Participants will be entered to win a free copy of CMA’s new Act Smart compliance guide CD-ROM, an easy-to-use reference for physicians who wish to minimize billing mistakes and avoid exposure to liability for fraud.

If you haven’t purchased the 2004 CPLH yet, click here for ordering information.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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8. We Don't Mean to Nag, But Have You Filled Out the Cost Survey Yet?
Physicians, please help. We need your data to help you. CMA is analyzing practice expense information from as many California physicians as possible, both members and nonmembers. The more survey responses we get, the better the resulting data will be. The deadline has been extended until August 31 to allow as many physician offices as possible to complete the survey.

The cost survey is designed to assist physicians and practice managers in measuring and improving their practice’s performance. The survey will be collected by and independent account firm and all identifiers will be removed. Survey results will include comparative information on revenue, staffing, staff salary costs, operating costs, and net practice income/loss. Most important, survey results will allow you to benchmark your practice costs against those of physicians with similar practice profiles.

All survey participants will automatically be entered to win a free iPAQ Pocket PC worth $400. Participants will receive a free copy of the survey report. CMA members who do not complete the survey may purchase the report for $100 (nonmembers $250).

Click here to complete the survey online or to download a PDF version of the survey to be submitted by mail or fax.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.

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9. Correction: Pain Management Conference Registration Fees
Early bird registration for CMA’s pain management conference is $255 for members, $510 for nonmembers. After August 16, registration will be $295 for members, $550 for nonmembers.

Register online or by calling 415/882-3330. The next conference takes place September 10-11 in Sacramento.

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For previous editions of CMA Alert, visit our news archives.

Prepared by the CMA Communication Center
Katherine Gallia, Editor,
916/551-2074, kgallia@cmanet.org
Noel Tatlonghari, Publishing Assistant,
916/551-2072, ntatlonghari@cmanet.org

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