[Congressional Record Volume 151, Number 154 (Friday, November 18, 2005)]
[Extensions of Remarks]
[Pages E2409-E2410]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     DEFICIT REDUCTION ACT OF 2005

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                               speech of

                             HON. LEE TERRY

                              of nebraska

                    in the house of representatives

                      Thursday, November 17, 2005

  Mr. TERRY. Mr. Speaker, as the House of Representatives considers 
passage of the Deficit Reduction Act, I rise in overall support of H.R. 
4241. As the process moves forward, I urge my colleagues in this 
chamber and in the conference to consider some additions and changes.
  The actual estimated average cost to a community retail pharmacy to 
dispense prescription drugs ($9.25) is greater than the minimum multi-
source dispensing fee established by H.R. 4241 ($8.00). Because H.R. 
4241 does not establish a dispensing fee for single source medications, 
commonly known as brand-name drugs, I urge my colleagues to consider an 
increase in dispensing fees for both single source and multisource 
medications that adequately compensates community retail pharmacies for 
their cost to dispense prescription drugs within the Medicaid program. 
In addition, I urge my colleagues to encourage the states to conduct 
mandatory comprehensive studies to determine actual distribution 
expenses incurred by community retail pharmacies participating in the 
Medicaid program so that fair and equitable distribution reimbursement 
rates can be established.
  We should also do all we can to provide incentives to increase the 
distribution of generic therapeutic equivalent drugs when they are 
available. While our bill provides higher dispensing fees for generics 
based on Retail Average Manufacturers Price (RAMP) plus cost, I still 
do not feel that there is enough incentive in our model to encourage 
effective use of generics. I encourage continued work in conference to 
increase the utilization of generics, which in itself has significant 
savings potential.
  H.R. 4241 establishes a new benchmark formula for establishing 
reimbursement rates for community retail pharmacies participating in 
the Medicaid program. The benchmark formula, known as RAMP, can often 
be significantly out of date because it is updated on a quarterly basis 
and it often is not determined and posted for another quarter. Because 
pharmaceuticals prices are updated on a daily basis, the RAMP has the 
potential to be as much as six months out of date. Accordingly, I urge 
my colleagues to consider modifying requirements related to RAMP from a 
quarterly recalculation basis to a monthly basis so that community 
retail pharmacies do not have to absorb significant financial losses 
due to fluctuations in real cost.

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