NCPA Submits Comments on CMS’ Proposed Guidance on DIR Reporting: This week submitted comments to CMS regarding their proposed guidance on how Part D plan sponsors report direct and indirect remuneration (DIR). While the proposed CMS guidance will not change existing policy with regard to DIR fees, it does have the potential to require plans to provide greater granularity to CMS on DIR amounts and the types of arrangements they put into place. CMS has responded positively to many of NCPA’s previous recommendations, and even issued an analysis showing the financial havoc retroactive pharmacy DIR fees are causing patients, taxpayers, and pharmacies. NCPA’s letter to CMS: commended the agency’s proposed 2016 report modifications on how DIR fees information is collected, especially with regards to “making the distinction between price concessions received from pharmacies and incentive payments paid to pharmacies by Medicare Part D sponsors”; suggested that CMS include additional categories to require plan sponsors to further define the amounts of DIR fees charged or paid to non-retail pharmacies; and urged CMS to require Medicare Part D plan sponsors to justify why DIR fees cannot be reasonably estimated at the point of sale. NCPA remains committed to ending retroactive pharmacy DIR fees by passing S. 413 / H.R. 1038, the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act,” however, we’re also committed to working with CMS to provide clarity on DIR fees as they currently exist via the regulatory process.
New York Times Points Out Independent Pharmacy Role in Drug Price Fight: NCPA’s campaign for patient access and PBM reforms have paid dividends as the New York Times, in a May 29 article about rising drug prices, pointed out the role independent pharmacists are playing. The article referenced the numbers of independents who visited House and Senate offices in Washington, D.C. (during the late April NCPA Fly-In). In the article, independent pharmacists described themselves as the industry’s “white hats.” They pointed a finger at PBMs such as Express Scripts and CVS Health. As the Times described it: “Want to reduce prescription drug costs?” the pharmacists argued during their visits. “Pay attention to the middlemen.” The article featured a photo of NCPA board member Hugh Chancy, RPh, wife Tina, and GPhA President Lance Boles of Hartwell, Ga., meeting with the staff of Rep. Hank Johnson (D-Ga.), and also used a graphic from NCPA’s PBM Storybook. Please click and share the link to the article. It’s your investments in our Legislative/Legal Defense Fund (LDF) that fuel NCPA’s entire advocacy operation—including building the kind of media relationships that result in a Pulitzer Prize-winning reporter seeking us out and then producing the kind of story that appeared on page one of The New York Times this week. Please consider doing your part and make a “fair share” LDF investment.
Members of Congress Object to FDA Compounding Final Guidance: In a letter to Scott Gottlieb, commissioner of the Food and Drug Administration, Reps. Chris Stewart (R-Utah), Buddy Carter (R-Ga.), and more than 60 other members of Congress expressed their “strong disappointment” with the final Guidance for Industry (GFI) issued by the FDA on Dec. 29, 2016, titled the “Prescription Requirement under 503A of the Food, Drug and Cosmetic Act.” The letter points out that the final GFI takes the position that state-licensed pharmacies cannot compound medications pursuant to state pharmacy laws for administration to patients in office or clinical settings (commonly referenced to as “office-use compounding”). In the letter, the lawmakers state that office-use compounding is a common and often necessary medical practice that is authorized in some form by the vast majority of state pharmacy laws. NCPA staff and our pharmacy partners worked together to raise awareness of the letter and generate additional signatures.
Institute for Policy Innovation Issues White Paper on Health Care Pricing Highlighting NCPA Endorsed Legislation: The Institute for Policy Innovation recently released a white paper on health care pricing noting problems with the way the U.S. pays for health care, through health insurers and pharmacy benefit managers (PBMs). The paper highlights the efforts of Reps. Doug Collins (R-Ga.), Buddy Carter (R-Ga.), Dave Loebsack (D-Iowa), John Sarbanes (D-Md.) and John Duncan (R-Tenn.), who have introduced H.R. 1316, the Prescription Drug Price Transparency Act that is designed to: safeguard patient information collected by a PBM (which can be used to steer patients to PBM-owned/preferred outlets), prohibit PBMs from requiring patients to utilize a PBM-owned pharmacy (including specialty pharmacy), requires maximum allowable cost (MAC) transparency, and to apply these standards to both TRICARE and the Federal Employee Health Benefits Program (FEHP). The paper also draws attentions to the efforts in the Senate by Senator Ron Wyden (D-Ore.), the ranking member of the Senate Finance Committee, who has proposed legislation to lower drug costs by targeting PBMs with S. 637, the Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017. NCPA has been involved with and supportive of both pieces of legislation. Here is a link to the paper: http://www.ipi.org/ipi_issues/detail/selective-transparency
CBO Scores House Passed ACA Repeal Bill: On May 24th CBO released the score for H.R. 1628, as amended and passed by the House on May 4th. The estimate predicated that enactment of the bill would reduce the federal deficit by $119 billion over the 2017-2026 period. That amount is $32 billion lower than the CBO estimate that was issued for the bill that was reported by the House Budget Committee and posted on the Rules Committee website in March. The $119 billion savings easily meets the requirements set forth in the reconciliation instructions that were included in the budget resolutions but it is noteworthy that the bill has yet to be formally sent over to the Senate for consideration.
NCPA Statement on Study of Rural Pharmacies and Medicare Part D: A recent government-funded study by the RUPRI Center for Rural Policy Analysis, “Issues Confronting Rural Pharmacies after a Decade of Medicare Part D,” found that direct and indirect remuneration (DIR) fees and low or delayed reimbursements continue to pose significant challenges to rural pharmacies and their ability to provide essential health services to their communities. Nearly 80 percent of the surveyed pharmacies in the RUPRI study found both DIR fees and MAC reimbursements to be a significant challenge for their business, while almost 60 percent struggled with being out-of-network. The study’s findings include the following:
- “With looming closure without replacement of many of these pharmacies, an estimated 3 million rural residents are at risk of losing the only pharmacy in their community. For many of these individuals, the nearest pharmacy is over 10 miles away.”
New Pharmacy Owners: Find Out How Your Pharmacy Compares to Other Start-Ups With New Report: Start-up pharmacies have traditionally had limited ability to evaluate their performance versus other new pharmacies in their first five years of business. For the second year, NCPA has addressed this gap in benchmarking data by producing the 2017 Community Pharmacy Start-up Benchmarking Report, sponsored by PCCA. New pharmacy owners will find this information especially valuable in comparing their pharmacy’s status to other start-from-scratch pharmacies. View the report on the NCPA website.
In the States:
- Texas: H.B. 3218 was sent to the Governor’s desk. This legislation clarifies the Department of Insurance (TDI) jurisdiction and oversight into complaints, payment methods to pharmacies, prior authorization processes, credentialing, pharmacy contracts, and other administrative duties of PBMs. The law also requires PBMs to register as “delegated entities” with TDI, disclosing their business practices and ensuring compliance with all laws and rules that apply to the insurers that PBMs contract.
- Texas: H.B. 1296 was sent to the Governor’s desk. This bill would allow a pharmacist to provide medication synchronization services to a patient on a chronic medication regimen. The law requires pro-rated copays but prohibits a pro-rated dispensing fee.
- Texas: NCPA State Government Affairs submitted a letter to the Governor in support of S.B. 1076. This bill would ensure that a patient’s copayment is no more than the lesser of the standard copayment, the allowable claim amount for the prescription drug, or the pharmacy’s cash price.
