Medicare Pharmacy Choice and Access House Bill Introduced This Week: The Ensuring Seniors Access to Local Pharmacies Act, H.R. 1939, was introduced by Reps. Morgan Griffith (R-VA) and Peter Welch (D-VT) on April 5th. The bill would allow community pharmacies in medically underserved areas to participate in Medicare Part D preferred pharmacy networks if they can meet the terms and conditions the networks require. Enactment of this bill would help many Medicare patients across the country who reside in highly rural and low-income urban areas across the country and we thank the sponsors for their leadership.
Administration Outreach: NCPA staff had a productive meeting with Mr. George Sifakis, Assistant to the President and Director of the Office of Public Liaison at the White House this week. Mr. Sifakis is responsible for communicating and interacting with various interest groups to further the goals and policies of the Trump administration. At the meeting NCPA provided an overview of the independent pharmacy marketplace and that as small business health care providers NCPA and its members are willing to partner with the administration on an array of issues including drug pricing, small business growth/tax reform and opioid abuse remedies.
Urge Your Legislator to Voice Support for TRICARE Pharmacy Pilot Program: The FY2017 National Defense Authorization Act (NDAA) authorized the Secretary of Defense to implement a pilot program to allow the Department of Defense (DoD) to access lower pricing for prescriptions dispensed at retail pharmacies. If authorized by the Secretary, this pilot would reduce prescription costs for the DoD, expand TRICARE beneficiary choice and access to prescription drugs at retail pharmacies, and streamline DoD administrative and prescription drug rebate processes. Please take a moment and contact your Representative (you can look up their contact information on the NCPA Legislative Action Center) and ask them to sign-on to a bipartisan letter led by Representatives Mike Coffman (R-CO), Walter Jones (R-NC) and Robert Brady (R-PA) to the Secretary of Defense urging him to utilize his authority to authorize this prescription drug pilot program. The deadline for legislators to sign-on is Friday, April 14.
NCPA, NACDS Oppose TRICARE Copay Hikes: NCPA and the National Association of Chain Drug Stores are urging Congress to block further TRICARE pharmacy copay increases. “Copay increases place even greater financial burdens on TRICARE beneficiaries and unfairly penalize TRICARE beneficiaries who prefer to use local pharmacies,” NCPA and NACDS wrote to congressional committees with jurisdiction over the Pentagon’s TRICARE program, which covers veterans and the families of active duty military personnel.
CMS Releases 2018 CMS Final Call Letter: The Call Letter provides updates to the Medicare Advantage (MA) and Medicare Part D programs. Policy changes impacting independent pharmacy include star rating changes, drug utilization review control changes to avoid over use of opioids, tiered formulary changes and more clarity surrounding access to preferred cost-sharing pharmacies (PCSPs). NCPA will provide a summary of key issues to members. Of note, CMS also released a Request for Information (RFI) as an attachment to the Final Call Letter soliciting input on “regulatory, sub-regulatory, policy, practice and procedural changes” to use “transparency, flexibility, program simplification and innovation” to provide MA and Medicare Part D enrollees with “options that fit their individual health needs.” The agency indicates recommendations could include those regarding benefit design, flexibility in operations or networks, and approaches to support the doctor-patient relationship in care delivery, as well as changes to plan payment, oversight and measurement. In addition, CMS is seeking input on ways to simplify its rules and policies. NCPA will submit comments by the April 24th deadline and will recommend improvements to Part D focusing on DIR and PBM transparency.
NCPA Attends MedPAC Meeting For DIR Discussion: NCPA staff attended the April 7th meeting of MedPAC (Medicare Payment Advisory Commission). One of the staff presentations focused on Payment and Plan Incentives in Medicare Part D and highlighted the growing concern regarding increased catastrophic spending and the ever growing delta between gross price and net price. MedPAC staff highlighted that the gap between gross and net price (DIR) has grown by more than 20% a year between 2010 and 2015. Many of the concerns that NCPA has been voicing with regard to DIR were also highlighted in the staff presentation. Commissioners identified several policies that could be considered to supplement the Commission’s 2016 Part D recommendation package, including making changes to how DIR received by Part D plans is factored in Medicare payments to these plans. There was “mixed support” among Commissioners on the proposed DIR allocation change, which would provide a more equitable allocation of DIR between plans and Medicare. The Commissioners generally agreed that more data was needed to assess how DIR allocation changes may impact plans and beneficiaries before advancing a DIR-related Part D policy.
Rep. Buddy Carter Visits Compounding Pharmacy in Leesburg, VA: Rep. Buddy Carter (R-Ga.) and NCPA advocacy center staff recently visited The Compounding Center, owned and operated by NCPA member Cheri Garvin. Additionally Rep. Carter is one of the leads on a letter to the FDA expressing Members of Congress disappointment with final guidance regarding office use compounding. This letter currently has over 50 Members of the House as signatories and we hope to get more members on in the coming weeks.
NCPA Presents The Real Story of PBMs: NCPA has produced a new resource for helping policymakers, patients, and the media know about the discrepancy between what PBMs say and the actual effect they have in driving up prescription drug prices and limiting patient access to medications. We call it The PBM Story: What They Say, What They Do, and What Can Be Done About It. It’s now available for download in either 6-page or 12-page formats on NCPA’s website.
Please download the resource and share it promptly with your members of Congress, your state legislators, other policymakers, local employers, and anyone else who needs to understand the truth about PBMs.
NCPA’s Fly-In: What You Need to Know: Make your voice heard by attending the NCPA Congressional Pharmacy Fly-In April 26-27 and meet with your elected officials. Attached please find pertinent information regarding the fly-in.
In the States:
- WA and Washington D.C.: Last week NCPA, NACDS and the Washington State Pharmacy Association (WSPA) filed suit against Washington State because the state Medicaid program is reimbursing pharmacies below the actual cost of dispensing prescriptions to Medicaid patients. The Washington State Health Care Authority changed the basis by which the agency reimburses pharmacies’ for the cost of acquiring pharmaceuticals, which reduced reimbursement to pharmacies for medications dispensed to Medicaid patients. However, the agency violated the law when it failed to increase Medicaid dispensing fees to cover the cost of dispensing. Dispensing fees must over the costs that pharmacies incur when they safely fill prescriptions, such as costs associated with pharmacists’ professional services. Medicaid dispensing fees in Washington State cover less than half the cost of dispensing. We are encouraged by recent progress on Medicaid reimbursement issues following the filing of the lawsuit, namely that the Washington, D.C. Medicaid program recently changed course on a virtually identical issue. As in Washington State, the D.C. Medicaid program originally announced that it would change the basis for reimbursing pharmacies for the cost of acquiring pharmaceuticals but would not immediately increase its dispensing fee. In a significant reversal, however, earlier this week the D.C. Medicaid agency decided to increase its dispensing fee from $4.50 to the $11.15. The agency applied the increase retroactively to April 1st.
- Georgia: S.B. 103 has passed both the House and Senate and now awaits the Governor’s signature. S.B. 103 covers many issues including providing the Insurance Commissioner with more oversight over PBMs. The bill also includes AMMO language and attempts to prohibit DIR fees. H.B. 206 was introduced and would ensure fair and uniform pharmacy audits conducted by the Department of Community Health.
- Louisiana: H.B. 428 was introduced and it prohibits a PBM from taking adverse action against a healthcare provider for: 1) discussing any healthcare issues/costs with patient/public 2) disclosing a practice by the PBM that is in violation of state law 3) Providing information or testifying before any public body conducting an investigation, hearing, or inquiry into any violation of law 4) Objecting or refusing to participate in a practice that is in violation of law or causes the provider financial loss.
- Montana: H.B. 276 was signed into law by Governor Bullock. This new law provides transparency into how Montana pharmacies are reimbursed by PBMs, and provides pharmacists with the option to “opt out” if they are reimbursed less than acquisition cost. Congratulations to the Montana Pharmacy Association and other pharmacy stakeholders.
- North Carolina: S.B. 384 was introduced and includes language that attempts to prohibit retroactive fees. The bill would also allow a pharmacist to provide information about a patient’s medication cost and if there are lower-priced alternatives available.
- North Dakota: Governor Burgum signed S.B. 2301 and S.B. 2258 into law. Both laws attempt to address a range of issues including requiring the PBMs to disclose “spread pricing” to the plan sponsor, DIR language, claw back language, and AMMO language. NCPA congratulates the North Dakota Pharmacists Association and other pharmacy stakeholders in the state on their hard work and success.
- Pennsylvania: NCPA participated on a call with the Pennsylvania Department of Health and Human Services and other pharmacy stakeholders to discuss their proposed reimbursement benchmark along with the results of their Mercer conducted COD study. Currently, the department is proposing AAC plus a $7.00 dispensing fee.
