Cigna Seeks to Acquire Express Scripts; NCPA Expresses Concerns
This week Cigna announced its intention to purchase Express Scripts. This announcement continues the consolidation trend in the health care marketplace and comes as regulators continue to examine the impacts on the proposed merger between CVS Health and Aetna, Inc. and consider whether to allow the merger to move forward. NCPA expressed serious concerns about this announcement in a public statement, noting in part, “We have expressed significant concerns about the proposed CVS Caremark-Aetna merger and believe similar concerns apply in this instance. Continued vertical health care consolidation could impede competition and foreclose any meaningful entry into the market, leading to fewer choices and higher health care costs. We believe rigorous antitrust scrutiny is critical to protect competition and ensure affordable patient access.” NCPA will continue to monitor this development and continue to urge close scrutiny of this proposed merger.
Arkansas Lawmaker Raises Concerns with Pending CVS/Aetna Deal, General PBM Practices
Independent community pharmacy champion Rep. Rick Crawford (R-Ark.) sent letters this week to U.S. Attorney General Jeff Sessions and Acting Chairwoman of the U.S. Federal Trade Commission Maureen Ohlhausen expressing “grave concern” over the proposed acquisition of Aetna Inc. by CVS Health. In the letter, Crawford writes “[CVS Caremark] has already run amok in my state by severely undercutting reimbursements to pharmacists…CVS Caremark and another PBM operating in the state paid community pharmacies on average between negative $2 to negative $4 per prescription across the entire market basket of services.” He further noted, “I earnestly request that, in addition to closely examining the consequences of a CVS/Aetna merger, that you also consider the broader question of PBMs’ owning retail and mail-order pharmacies and setting reimbursement rates.”
3/16 is Hotel Deadline for NCPA’s 2018 Congressional Pharmacy Summit
You’ll have the opportunity to make Capitol Hill visits to tell your member of Congress what your business and patients need from Washington. And they’ll listen — as a constituent and business owner, you have a lot of power. Before you hit the Hill, we’ll give you a legislative briefing. We’ll give you the latest Medicare and Medicaid updates. And you’ll hear two of our Congressional champions talk about how things get done in Washington. See the attached agenda for more information. Register today to reserve your spot at the Summit and save money on your hotel room (the special NCPA rate goes away Saturday). Don’t pass up this opportunity to lobby for your business. You’ll have the attention and ear of your member of Congress — and you’ll do your profession good.
NCPA-Supported Congressional Candidates Advance in Texas Primary Election
The Texas congressional primary was Tuesday of this week and two candidates that the NCPA PAC supported in open seat races were successful in moving on to the next level. In addition to financial support from the NCPA PAC, NCPA also sent out get out the vote messages to all members residing in these districts encouraging them to vote for NCPA’s preferred candidate. In TX-2 where Republican Rep. Ted Poe is retiring NCPA supported state Rep. Kevin Roberts in a 9-way Republican primary where Roberts was the top vote getter w/ 33% and will face 2nd place finisher Dan Crenshaw.
In TX-6 where Republican Rep. Joe Barton is retiring NCPA supported Ron Wright in a 13-way Republican primary where Wright was the top vote getter w/ 45% and will face 2nd place finisher Jake Ellzey.
Due to Texas law since neither candidate received a majority of the vote they are both headed to a May 22nd runoff election. If they are successful in the Republican runoff they will face nominal Democrat opponents in the general election as both districts are solid Republican.
NCPA Submits Comments on Proposed 2019 Call Letter
This past Monday, NCPA sent comments to the Centers for Medicare and Medicaid Services (CMS) outlining community pharmacists’ concerns regarding CMS’ proposed changes to 2019 Part D plans. NCPA’s comments focus on hard edits for dispensing opioids, enhancements to the 2019 star ratings, potential changes to the Part D Mail-Order refill consent policy, and plans’ incomplete and inaccurate bid submissions. CMS’ final call letter for 2019 Part D plans is expected to be released on April 2nd. NCPA will provide a summary for members once the call letter is released.
Key Officials Target Middlemen as a Cause of High Health Care Cost
This week, two key administration officials discussed the role of PBM middle men contributing to higher prescription drug costs. Secretary of Health and Human Services (HHS) Alex Azar, in a speech to the Federation of American Hospitals, discussed the need for greater transparency in the U.S. health care system, including for prescription medications, stating “Your pharmacist typically cannot tell you the real price you’re going to pay for a drug, and therefore your out-of-pocket cost, until they actually create a claim. So this is a crucial piece of our efforts to bring down prescription drug prices, too.” He also noted “This thicket of negotiated discounts makes it impossible to recognize and reward value, and too often generates profits for middlemen rather than savings for patients.” Meanwhile, Scott Gottlieb, Commissioner of the Food and Drug Administration, specifically called out PBMs noting that their negotiated savings aren’t being passed along to patients at a speech to the America’s Health Insurance Plans.
United Health Announces it Will Pass Rebates onto Patients
United HealthCare’s announced this week that enrollees in fully insured group health benefit plans will have manufacturer rebates and discounts applied to their medication cost at the point of sale. This move was praised by HHS Secretary Azar who said the effort will help “empower” patients with the “information and control to put them in the driver’s seat,” which is a key part of HHS’ strategy to “bring down the price of drugs and make healthcare more affordable.” The Wall Street Journal, a subscription based publication, had a graphic on rebates and how they are allocated.
NCPA Staff Present on Behalf of Community Pharmacy
NCPA’s VP of Pharmacy Affairs Ronna Hauser, PharmD, presented this past weekend at the American College of Apothecaries (ACA) Annual Conference and Expo. Her presentation, Legislative Update for Pharmacy, covered important topics for pharmacies including pertinent compounding updates, recent DIR related activity, and pertinent state legislative and legal activity.
NCPA’s SVP of Communications & State Government Affairs Scott Brunner, CAE, presented an overview of PBM regulation this past weekend at the National Conference of Insurance Legislators conference in Atlanta. He was joined by Arkansas Pharmacists Association Executive Director Scott Pace, JD, PharmD. The two made the case that both patients and pharmacies are disadvantaged by insufficient or nonexistent PBM regulation in states across the nation. NCOIL is considering developing a model comprehensive PBM oversight legislation.
In the States …
- Arizona HB 2107, which prohibits PBMs from restricting pharmacists from providing information to patients on medication costs, passed the House and is now in the Senate.
- Florida HB 351, which requires PBMs to register with the Office of Insurance Regulation, provides for generic drug pricing transparency, and prohibits PBMs from restricting pharmacists from providing information to patients on medication costs or charging patients a copay higher than the reimbursement received by the pharmacy, passed both chambers and is headed to the governor.
- Hawaii SB 3104, which would place PBMs under the purview of the Department of Commerce and Consumer Affairs and provide for generic drug pricing transparency, passed the Senate and is in the House.
- Indiana HB 1317, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs or charging patients a copay higher than the reimbursement received by the pharmacy, passed the Senate and was returned to the House with amendments.
- Kentucky HB 463, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs or charging patients a copay higher than the cost of the medication without using a health plan benefit, passed the House and is in the Senate.
- Mississippi HB 709, which prevents PBMs from prohibiting pharmacists’ ability to provide information to their patients regarding the options that patient has in paying for prescription medications, was signed into law by the governor.
- New York AB 6733, which contains provisions related to fair pharmacy audit practices, passed the Assembly and is in the Senate.
- New York AB 8781, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs, passed both chambers and is headed to the governor.
- South Carolina S 815, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs, charging patients a copay higher than the reimbursement received by the pharmacy, charging claim adjudication fees, and prohibiting delivery as an ancillary service of a pharmacy, passed the Senate and is now in the House.
- Utah SB 184, which allows pharmacists to prescribe self-administered hormonal contraceptives under a standing prescription drug order, passed both chambers and is headed to the governor.
- Utah SB 208, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs and requires a reimbursement report for any direct and indirect remuneration fees charged be made available to a pharmacy, passed both chambers and is headed to the governor.
- Virginia SB 933, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs or charging patients a copay higher than the reimbursement received by the pharmacy, passed both chambers and is headed to the governor.
- West Virginia SB 46, which prevents PBMs from restricting pharmacists’ ability to provide information to patients on medication costs, is in conference between the House and Senate.
