CMS rejects below-cost dispensing fees

In a decision that has strong support from NCPA and other pharmacy stakeholders, the Centers for Medicare and Medicaid Services has rejected Washington state's below-cost and lowest-in-the-nation Medicaid pharmacy dispensing fees. This action should spur Washington to increase its dispensing fees and demonstrate to other Medicaid programs that dispensing fees must cover pharmacies' costs. This increase in dispensing fees must be supported by pharmacy cost data, and under federal rules should be applied retrospectively effective April 1, 2017.

In a joint statement, NCPA, along with the National Association of Chain Drug Stores and the Washington State Pharmacy Association, said, "CMS has taken action that is consistent with the Covered Outpatient Drugs final rule and that is consistent with the health and wellness of our most vulnerable patients. We strongly support this pivotal development, which will prove highly significant for pharmacy patient care in Washington state and nationwide. We will continue to advocate in support of this pro-patient and pro-pharmacy position."

CMS officials visit Halethorpe Pharmacy

This week, NCPA member George Garmer hosted CMS Medicare Part D staff in his pharmacy in Halethorpe, MD. Approximately 8 staff attended with oversight for issues such as DIR, opioids, formulary and benefit management, and policy. NCPA greatly appreciates George and his invitation to these important policymakers.

NCPA Annual Convention only 3 weeks away

NCPA Annual Convention is only 3 weeks away. There is still time to register to take advantage of more than 30 CE programs designed to help you increase your numbers of patients and prescriptions, increase your revenue, lower your costs and make your pharmacy more competitive. Additionally, you can take advantage of up to $14,000 in attendee only discounts offered at the trade show and expo. See the complete convention schedule for more.

NCPA raises small business concerns
with administration officials

This week NPCA staff, including NCPA’s Diana Courtney, and NCPA officer Michael Kim met with the Office of Management and Budget and the Environmental Protection Agency regarding a final rule on disposal practices for pharmaceutical hazardous waste currently under OMB review. The rule, if finalized, would change current business practices between pharmacies and reverse distributors, including a requirement that pharmacies make distinctions between potentially creditable and non-creditable hazardous pharmaceutical waste before sending any products to a reverse distributor. Kim and Courtney provided concrete examples on how this requirement and other requirements in this rule would impact community pharmacies. Other industry stakeholders are weighing in on the challenges with implementation of this rule, including representatives from the distributors and reverse distributors sectors. NCPA expects OMB to finish reviewing the rule this fall.

House Energy and Commerce Committee
advances “gag clause” bill

This week, the House Energy and Commerce Committee advanced H.R. 6733 authored by Reps. Buddy Carter (R-Ga.), Erik Paulsen (R-Minn.) Lloyd Doggett (D-Texas), Peter Welch (D-Vt.), Cathy McMorris Rodgers (R-Wash.), Anna Eshoo (D-Calif.), Morgan Griffith (R-Va.), Debbie Dingell (D-Mich.), Michael Burgess (R-Texas) and Gene Green (D-Texas). The legislation addresses “gag clauses” by prohibiting group health plans, health insurance issuers, prescription drug plan sponsors, and Medicare Advantage organizations from restricting a pharmacy’s ability to inform a patient the lower cost, out-of-pocket l price for their prescription. In his opening statement, Committee Chairman Greg Walden (R-Ore.) referenced NCPA board member Michele Belcher, which can be viewed at about the 24:00 mark of the hearing video. Additionally, Carter speaks about the bill starting around 33:00 and mentions the take it or leave it nature of contracts. The legislation will likely be voted on in the full House the week of Sept. 24.

Senate delays vote on opioid package

Due to hurricane Florence, the vote on the Senate’s opioid package scheduled for this week was cancelled. The vote is likely to be rescheduled for the week of Sept. 17. The package contains more than 70 provisions reported out of five Senate committees. Once the package is passed in the Senate, the bill will go to conference where House and Senate negotiators will settle the policy differences between the two chambers. Republicans would like to send a final bill to the president prior to the midterm elections.

NCPA attends PCAC meeting at FDA

The FDA held its 9th Pharmacy Compounding Advisory Committee (PCAC) Meeting this week. NCPA was in attendance and participated in efforts to defend one of the bulk substances that was on the agenda. Fortunately, the substance that NCPA nominated, pyridoxal 5 phosphate, was voted unanimously to be included on the 503a bulks, or positive, compounding list for 503a pharmacies. Other substance that were voted unanimously to be included on the list and therefore continue to be used in compounding include alpha lipoic acid, coenzyme Q10, and creatine monohydrate. The only bulk substance voted NOT to be included on the list was quercetin. NCPA will continue to remain actively involved in the PCAC process.

NCPA provides advocacy updates at pharmacy meetings

NCPA's Scott Brunner presented a Federal & State Advocacy Update last weekend at EPIC Rx’s 2018 Multi-State Legislative Advocacy Summit in St. Petersburg, Florida. Attendees included EPIC’s state contract lobbyists and independent pharmacists serving as advocates in the EPIC network. In addition to reporting on NCPA’s current work with the Trump Administration to eliminate pharmacy DIR fees in Part D, Brunner shared a recap of 2018 state legislation and surveyed a number of possible approaches for addressing state Medicaid contracting, transparency and reimbursement issues in 2019 legislative sessions.

Additionally, last week, NCPA’s Kala Shankle presented on the legislative and regulatory landscape regarding DIR fees and NCPA’s advocacy efforts on this issue at the Virginia Pharmacists Association’s Convention. The presentation also focused on solutions to DIR fees, including participating in the state’s CPESN group.

Shankle also presented this week at the New England Pharmacists Convention on federal and state laws and regulations that are impacting the practice of pharmacy, including NCPA’s advocacy efforts at both levels to support community pharmacies. The presentation also highlighted changes to Part D recently announced in the 2019 Final Part D Rule and the 2019 Call Letter. NCPA’s regulatory and policy team will be hosting a webinar detailing changes to Part D 2019 plans this fall. Details will be forthcoming.

NCPA Submits Comments to Proposed Revisions
to the Physician Fee Schedule and Part B

This week, NCPA submitted formal comments to the Centers for Medicare and Medicaid Services (CMS) regarding proposed revisions to payment policies under the physician fee Schedule and other revisions to Part B for CY 2019. NCPA focused on emphasizing the pharmacists’ role in virtual patient monitoring and evaluation and management services. NCPA also asked CMS to include pharmacists in the new bundled episode of care for management and counseling treatment for substance use disorders, providing examples of how independent pharmacists are providing many of these counseling and medication management services already. In addition, NCPA signed on to the Pharmacy HIT Collaborative’s joint comments to these proposed revisions, including comments on telehealth and PDMP.

NCPA attends MACPAC public meeting

NCPA state government affairs staff attended the Medicaid and CHIP Payment and Access Commission public meeting this week. Discussions were held on a variety of issues, including Medicaid coverage of new and high cost drugs and managed care oversight. NCPA staff will continue to monitor and engage in discussions and recommendations related to Medicaid topics affecting our members.

NCPA’s Advocacy Center Update provides a weekly detailed summary of recent and breaking legislative, regulatory, and state developments impacting independent community pharmacy and NCPA’s efforts to affect policies benefitting its membership and the industry. The weekly update is distributed to NCPA leadership, steering committees, allied organizations/stakeholders and major contributors to the NCPA LDF and PAC.