Only one week left to voice support for proposed DIR fix

Nearly 2,700 pharmacist comments have been submitted to CMS supporting their efforts to eliminate retroactive pharmacy DIR fees. If you have not yet submitted your own comments, time is running out to do so. The comment period closes next Friday, January 25. This is a proposal that would help provide predictability and certainty for your pharmacy. Not only that, but for patients in Medicare Part D, the proposal could result in net savings of more than $200 annually for the average senior. Don’t delay! Comment on the proposal, if you haven't already. Gin up patient support on social media, or through a letter to the editor you submit to your local paper, or by utilizing the bag stuffer created by NCPA. We have tools to help on our #FixDIR resources page.

Registration now open
for 2019 NCPA Congressional Pharmacy Fly-in

Registration opened this week for NCPA's Congressional Pharmacy Fly-In, April 10-11 in Alexandria, Va. and Washington, D.C. This is your opportunity to meet with your members of Congress, or their staff, and personally ask them to support pro-community pharmacy legislation pending in the House and Senate. Plus, earn up to 3.5 hours of CE credit at briefings on a range of issues, including DIR fees and potential changes to Medicaid. Registration opens today, so register now online or by calling 1-800-544-7447, and plan to make your voice heard.

Republicans appoint new members
to Energy and Commerce and Ways and Means Committees

This week, House Republicans appointed members to key committees of jurisdiction for pharmacy related matters. Rep. Greg Gianforte (Mont.) joined the Energy and Commerce Committee. Meanwhile, the Ways and Means Committee added three new members: Reps. Jodey Arrington (Texas), Drew Ferguson (Ga.), and Ron Estes (Kan.). NCPA congratulates these members for their committee appointments and looks forward to continuing to work with them on key legislative issues

Members named to E&C Health Subcommittee

This week, The Energy and Commerce Committee also set the roster for its Health Subcommittee. The Health subcommittee is the starting point for many of community pharmacy’s legislative priorities, and the members of the subcommittee are key to advancing legislation. If you are represented by one of the members on the subcommittee, we encourage you to reach out and invite them for a pharmacy tour so they can see first-hand the important role community pharmacy plays in the health care systems of their districts and why it is important that they support pro-patient and pro-pharmacy legislative initiatives. Contact NCPA’s Michael Rule at michael.rule@ncpanet.org for more information on scheduling a pharmacy visit.

E&C Health Subcommittee membership:

Majority
Rep. Anna Eshoo (Calif.) – Chair
Rep. Eliot Engel (N.Y.)
Rep. G.K. Butterfield (N.C.)
Rep. Doris Matsui (Calif)
Rep. Kathy Castor (Fla.)
Rep. John Sarbanes (Md.)
Rep. Ben Ray Luján (N.M.)
Rep. Kurt Schrader (Ore.)
Rep. Joseph P. Kennedy III (Mass.)
Rep. Tony Cárdenas (Calif.)
Rep. Peter Welch (Vt.)
Rep. Raul Ruiz (Calif.)
Rep. Debbie Dingell (Mich.)
Rep. Ann Kuster (N.H.)
Rep. Robin Kelly (Ill.)
Rep. Nanette Barragán (Calif.)
Rep. Lisa Blunt Rochester (Del.)
Rep. Bobby Rush (Ill.)
Rep. Frank Pallone, Jr. (N.J.) – Ex Officio

Minority
Rep. Michael C. Burgess, M.D. (Texas), Republican Leader
Rep. Fred Upton (Mich.)
Rep. John Shimkus (Ill.)
Rep. Brett Guthrie (Ky.)
Rep. Morgan Griffith (Va.)
Rep. Gus Bilirakis (Fla.)
Rep. Billy Long (Mo.)
Rep. Larry Bucshon (Ind.)
Rep. Susan Brooks (Ind.)
Rep. Markwayne Mullin (Okla.)
Rep. Richard Hudson (N.C.)
Rep. Buddy Carter (Ga.)
Rep. Greg Gianforte (Mont.)
Rep. Greg Walden (Ore.), Ex Officio

IRS releases final small business pass through rule

This Friday afternoon, the IRS released its final rule on the provisions of the tax legislation passed in late 2017. The regulations detail the new 20 percent deduction for pass-through business owners. Of particular note, NCPA has been tracking this regulation for its implications on small business community pharmacists’ ability to be eligible to take the pass-through deduction. The final rule released today affirms that pharmacists will be included as a “Specified Service Trade or Business” or “SSTB,” a class of businesses that are not eligible for the pass-through unless an exception applies. A relevant exception applies to pharmacies that only conduct medical services that account for 10% (or under) of their total business (this exception is known as the “de minimis rule”). NCPA is currently reviewing this final rule for its implications on community pharmacies and will have a detailed analysis in the near future.

NCPA responds to resolution of dispute
between CVS and Walmart

Today, NCPA CEO Doug Hoey released a statement responding to the apparent resolution of the contract dispute over reimbursement rates between CVS and Walmart. Upon news that Walmart had agreed to renew its contract with CVS, Hoey stated in part, “If America's largest retailer must publicly brawl with PBM middlemen for 'mutually agreeable' reimbursement, what leverage do independent community pharmacy owners have?” NCPA will continue to work towards a transparent and fair pharmacy payment model.

NCPA submits comments
on Medicaid managed care proposed rule

This week, NCPA submitted comments to CMS on proposed changes to the Medicaid and CHIP managed care program. Our comments focused on changes to network adequacy standards, federal and alternative quality rating systems in Medicaid, delivery system and provider payment initiatives, and accountability and program integrity in subcontractual relationships between managed care organizations and PBMs. A copy of the submitted comments is available here.

CMS introduces model to encourage dispensing
of lowest list price medications

Today CMS announced a new model through its innovation center, which seeks to encourage Part D plans to include drugs with lower list prices on their formularies by shifting more risk to plans if patients enter the catastrophic phase of the Part D benefit. Currently, the government picks up about 80 percent of the tab for patients who enter catastrophic phase of the benefit. CMS asserts that the model seeks to address the “perverse incentives” that leave “plans with little reason to negotiate lower costs for the highest-spending patients” because of the savings a plan can incur due to the catastrophic phase. CMS seeks to save the government about $2 billion in just one year through the use of this model.

The new model titled The Part D Payment Modernization model requires participating plans to take on two-sided risk, where CMS will calculate a target for government spending if plans had not taken on the additional risk. Then, Part D plans will share in the government’s savings if plans stay below that target. In the alternative, plans that go above the target will be required to take on a loss.

Part D plans and Medicare Advantage plans can participate and applications are due by March 1. NCPA is analyzing the details of this model for its impact on community pharmacies operating in Part D.

MedPAC holds monthly meeting on state
of the Medicare program

This Thursday, the Medicare Payment Adivisory Committee (MedPAC) held its monthly meeting on the state of the Medicare program. This month’s meeting focused on a general overview of the statute of the Medicare Part D program, and highlighted that this upcoming April MedPAC will dive deeper into issues related to coverage gap liability and out-of-pocket spending. In the general overview, there was general consensus among Commissioners that changes in beneficiary, plan and manufacturer liability in the coverage gap should be considered in light of several unintended consequences; for example, Commissioner Amy Bricker of Express Scripts stated that the recent statutory increase in manufacturers’ liability in the coverage gap may result in higher list prices. Other Commissioners questioned whether the corresponding decrease in plan liability in the coverage gap may “erode” plans’ incentives to control costs. Several Commissioners expressed interest in analyzing the recent new Part D policies – such as indication-based formularies and allowing Medicare Advantage (MA) Part D plans to use step therapy for Part B drugs - and whether these policies address or impact issues with the Part D benefit structure. Chairman Crosson stated that these policies are relevant to the Commission’s ongoing Part D work, but noted that these policies will be discussed more in-depth in the January 18, 2019 MedPAC session, Future Policy Directions to Address Medicare Prescription Drug Spending. NCPA continues to monitor MedPAC’s meetings as seeks opportunities to address the committee on issues relevant to community pharmacies.

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.