NCPA to Discuss Impact of PBMs on Community Pharmacy at FTC Public Workshop: As reported in last week’s update, the Federal Trade Commission will hold a workshop on November 8, 2017 entitled, “Understanding Competition in Prescription Drug Markets: Entry and Supply Chain Dynamics.” NCPA’s Vice President of Policy & Regulatory Affairs, Susan Pilch, JD, will present during the second session that is focused on the role in intermediaries in the drug supply chain. Susan will discuss the impact of PBMs on drug prices and community pharmacies and how PBM practices can impact the prices consumers pay for drugs. The workshop, which is free and open to the public, will be at the FTC’s Constitution Center Auditorium, 400 7th St., SW, Washington, DC. The event begins at 8:30 a.m. and will be webcast live on the FTC’s website. Registration information, an agenda, directions to the FTC Conference Center, and a list of speakers will be available on the event web page. Advance registration is not required, but is strongly encouraged.
Representative Carter at NCPA Annual Convention: NCPA is pleased to announce that Rep. Buddy Carter (R-Ga.), the only pharmacist currently serving in Congress, will be making remarks during the Second General Session on October 16, 2017, at the NCPA Annual Convention. Additionally, the NCPA Political Action Committee (NCPA PAC) is hosting a fundraising reception and soliciting personal contributions from NCPA members to benefit Carter’s re-election campaign the same evening.
NCPA Co-Hosts Capitol Hill Health Fair: NCPA, along with the American Pharmacists Association, American Society of Health-Systems Pharmacists, National Association of Chain Drug Stores and Walgreens hosted a health fair this week on Capitol Hill. In conjunction with American Pharmacists month, Members of Congress and their staffs were invited to attend the event where health screenings and flu vaccinations were provided. Representatives Buddy Carter (R-Ga.) and Dave Loebsack (D-Ia.), who are both pharmacy champions, attended the fair.
E&C Member Day Addressing Opioid Crisis: This week the house Energy and Commerce Health Subcommittee held a hearing entitled “Member Day: Testimony and Proposals on the Opioid Crisis.” Over 50 Members, including those sitting on the Energy and Commerce Committee and others, highlighted proposals to address prevention, treatment, recovery, and law enforcement activities to attack the opioid crisis on multiple fronts. Representatives Buddy Carter (R-Ga.) and Peter Welch (D-Vt.), recommended giving pharmacists greater authority to authorize partial fills of opioid prescriptions on their own. Other pharmacy related issues addressed by Members included: provider training and education to avoid over-prescribing of opioids; need to ensure reimbursement for alternative pain management treatments; incentives for providers to become addiction treatment specialists; and electronic transmission of controlled substance prescriptions in Medicare Part D. NCPA is monitoring several opioid related bills in the House and Senate and has provided guidance to the bill authors to ensure patients have access to legitimately needed drugs, while also preventing diversion and abuse of prescription drugs.
U.S. House Subcommittee Holds Hearing on 340BDrug Pricing Program: On Wednesday, the House Subcommittee on Oversight & Investigations held a hearing on “Examining How Covered Entities Utilize the 340B Drug Pricing Program.” The overall theme of the hearing was the significant program growth in recent years, the lack of transparency regarding total program savings and how entities use such savings, the volume of drugs prescribed by 340B entities, and whether the 340B program is incentivizing the acquisition of oncology practices by 340B hospitals. Five covered entity witnesses presented testimony regarding the 340B program at their facilities. During member questioning, members focused on how 340B covered entities currently track and allocate their 340B savings; the types of data that could be used to create enhanced reporting requirements, including the “Community Benefit” section of an Internal Revenue Service (IRS) reporting form; CMS’ recent proposal to reduce Part B drug reimbursement for 340B hospitals; and increasing rates of 340B hospital acquisitions of oncology clinics. Of specific note, Rep. Buddy Carter (R-Ga.) questioned the fast expansion of 340B at covered entities, and requested specific documents from the representative/witness of Northside Hospital Inc. regarding its acquisition of oncology clinics from 1992 to today. He also requested documents from Johns Hopkins regarding the number of 340B drugs distributed to Part B recipients, and noted that the 340B program often implicates issues with Part D.
President Issues Executive Order “Promoting Healthcare Choice and Competition Across the United States”: On Thursday, President Trump released the Presidential Executive Order (“EO”): “Promoting Healthcare Choice and Competition Across the United States.” The EO focuses on expanding the usage of three types of health mechanisms: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).
- AHPs-The EO directs the Secretary of Labor to “consider” revising employers ability to form more AHPs, which could potentially allow employers in the same line of business to form groups across state lines. This would be a broader interpretation of ERISA than is currently practiced.
- STLDI-The EO directs the Secretaries of the Treasury, Labor, and Health and Human Services to “consider” expanding STLDI to more people, allowing for longer coverage periods and changes to its renewal process. STDLI is a low-cost, but short-term insurance plan with very limited coverage.
- HRAs-Likewise, the EO directs the Secretaries of the Treasury, Labor, and Health and Human Services to “consider” increasing the usability of HRAs, to expand employers’ ability to offer HRAs to their employees. HRAs are employer funded accounts meant to reimburse employees for healthcare expenses (copays, deductibles, etc.)
The key word in this EO is for agencies to “consider” implementing parts of this EO, which is not a directive for the aforementioned agencies to specifically design any regulations or guidance. If any of these policies are implemented, however, the makeup of the insurance industry could change drastically and could ultimately impact prescription drug benefit and other plans. While currently the EO does not expressly implicate issues for pharmacists, NCPA will actively monitor HHS’ and other federal agencies’ response to implement the policies laid out in the EO.
HHS Announces Elimination of Government Subsidy Payments to Plans: Late Thursday, the Department of Health and Human Services (“HHS”) announced the federal government will no longer make cost-sharing reductions (aka “CSR” payments) to private insurance companies. By way of background, the Affordable Care Act (“ACA”) requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. The federal government then reimburses insurers for discounts on co-payments and deductibles. This subsidy is known as the “CSR” payment. President Trump announced that the government’s subsidy payments to health insurance companies will end, but insurance companies will still be required under the ACA to provider reduced costs. Ending CSR payments will change the insurance industry as the end of CSR payments may drive up premiums as insurers attempt to cover the cost of the reductions. NCPA will continue to monitor how other parts of the government react to this change, including reaction from Congress, who could adopt a specific appropriation to ultimately fund the CSRs.
CMS Releases Star Ratings for 2018 MA and PDP Plans: CMS indicates that in 2018, approximately 73% of MA plan enrollees with prescription drug coverage, and 47% of PDP enrollees, will be in plans with 4 and 5 stars. The agency indicates the percentages of enrollees in 4- and 5-star MA and PDP plans have increased from 2017. CMS also estimates that MA average monthly premiums will decrease by $1.91 in 2018, to $30/month. Open Enrollment for 2018 MA and PDP plans begins October 15, 2017 and ends December 7, 2017. More information can be found in the attached press release and at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html.
