House letters express bipartisan support
for CMS’ DIR proposal

This week, both the Alabama & Arkansas House delegations sent letters to Health and Human Services Secretary Azar, voicing support for the provisions of CMS’s proposed rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, which would reform the use of pharmacy direct and indirect remuneration (DIR) fees, or pharmacy price concessions, in the Medicare Part D program. The Alabama letter was led by Rep. Bradley Byrne (R-Ala.) and was signed by 6 members of the delegation, including Ways & Means Health Subcommittee member Rep. Terri Sewell (D-Ala.). The Arkansas letter was led by Rep. Rick Crawford (R-Ark.), who was joined by the other three Congressmen from the state. In the coming weeks, NCPA expects more Congressional letters of support for the proposed rule, which would stop the retroactive clawback of DIR fees and would save Medicare beneficiaries $7-9 billion in their out of pocket drug costs over the next decade.

Congressman Doug Collins to speak
at 2019 NCPA Congressional Pharmacy Fly-in

This week, community pharmacy champion Rep. Doug Collins (R-Ga.) confirmed he will speak at the 2019 NCPA Congressional Pharmacy Fly-in (April 10-11). Collins has introduced past legislation to bring transparency to generic drug reimbursements and has supported legislation to eliminate retroactive pharmacy DIR fees and open Medicare preferred networks to all pharmacies willing to accept the contractual terms. He has also spoken passionately on the floor of the House of Representatives on the importance of community pharmacy. In addition to hearing from Congressman Collins, this is your opportunity to meet with your members of Congress, or their staff, and personally ask them to support a pro-community pharmacy legislative agenda. Plus, you can 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 is open, so don’t delay, register now online or by calling 1-800-544-7447, and plan to make your voice heard.

Senate Finance Committee holds hearing on drug pricing

This week, the Senate Finance Committee held a hearing entitled, “Drug Pricing in America: A Prescription for Change, Part I.” Chairman Charles Grassley (R-Iowa) stated that drug pricing will be the “first priority” for the Finance Committee this Congress, and stated his intent to focus on transparency and accountability-related measures – such as including drug prices in advertisements and “getting to the bottom” of insulin price increases. The Members and witnesses discussed a wide-range of potential policy reforms, including changes to Medicare Part B provider reimbursement, reforms to the Part D “catastrophic coverage” category, and the Administration's proposed International Pricing Index (IPI) Model, among others. Ranking Member Ron Wyden (D-Ore.) charged that the current system “prioritizes quarterly earnings over human lives,” and he and other Democratic Members stated interest in pursuing several areas of reform: pharmacy benefit manager (PBM) transparency, allowing Medicare to negotiate to “get better deals for patient and taxpayers,” and reforming the Part D benefit to shift more liability to plans and manufacturers. There was bipartisan support for several measures discussed during the hearing, including reforming or replacing the current percentage-based add-on payment for Part B drugs, restructuring plan liability in different stages of the Part D benefit, and examining the use and/or transparency of rebates in Part D.

E&C Committee leaders demand answers
from manufacturers on insulin price spikes

On Wednesday, House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-N.J.) and Oversight and Investigations Subcommittee Chair Diana DeGette (D-Colo.) sent letters to the three manufacturers of insulin in the U.S.– Eli Lilly, Novo Nordisk, and Sanofi – requesting information on the root causes of the rising cost of insulin and the obstacles to providing more affordable medication. “When patients go without insulin—or ration their doses—there can be tragic consequences,” Pallone and DeGette wrote in their letters. “News reports have highlighted stories of diabetics who have died because they could not afford insulin. No American should suffer because they could not afford their insulin. As one of the few manufacturers of insulin in the United States, your company is well-suited to shed light on these issues and offer potential solutions.” As part of their inquiry, the Democrats are requesting documents and answers from each of the companies by February 13, 2019 to a series of questions, including the history of price increases and their root causes, as well as an barriers preventing prices from lowering.

HHS releases a proposed rule to remove the safe harbor
protections that currently exist for rebates
between manufacturers and PBMs
in Part D and Medicaid Managed Care

Late Thursday, HHS released a proposed rule that would exclude rebates paid by manufacturers to plan sponsors under Medicare Part D and Medicaid MCOs from the discount safe harbor. The proposed rule also creates a new safe harbor that allows for price reductions on pharmaceutical product if such reductions are reflected in the price charged to the patient at the pharmacy counter. Finally, the proposal states that it is not HHS’ intention that these changes alter current safe harbors that protect discounts on products offered to other entities, including pharmacies. NCPA is analyzing the proposed rule for its impact on community pharmacies and will be communicating our analysis in the near future.

CMS releases its annual draft call letter
for 2020 Medicare plans

Early this week CMS released its annual draft call letter, which outlines the parameters a Medicare plan must meet to participate in the program. NCPA has identified three areas of interest for community pharmacy: 1) updates to Star Rating Measures; 2) new opioid policies from the SUPPORT Act for beneficiaries that are at risk-ask for opioids abuse; and 3) modifications to the current Part D mail order auto-ship policy. Of particular note, NCPA will be commenting on CMS’ proposal to, starting in 2020, permit interested Part D sponsors to offer an opt-in voluntary auto-ship program for refills of established therapies. This proposal for 2020 would replace the current affirmative prior consent step required for sending refills not initiated by the beneficiary and permit sponsors to offer an optional auto-ship option for refills of drugs that a beneficiary has been on for at least 4 consecutive months. Should you have any comments on these policies outlined in the draft call letter, please reach out to NCPA’s regulatory and policy team.

Georgia MCOs to cease spread pricing

Thanks to the work of the Georgia Pharmacy Association, Georgia’s four Medicaid Managed Care organizations all agreed to stop allowing spread-pricing in their next PBM contracts. Instead, the MCOs will move to a pass through pricing model. The change is a step towards fairer treatment for pharmacies participating in Georgia’s Medicaid program.

Help determine the cost of dispensing

NCPA is cosponsoring a survey on the cost of dispensing along with the National Association of Chain Drug Stores and the National Association of Specialty Pharmacy. It is critical that pharmacy owners complete this survey to help determine the actual cost of dispensing medications. The results will help us demonstrate to Medicaid agencies and other payers exactly how much it costs community pharmacies to dispense a medication, critical information that will be used to advocate for their pharmacy business.

The survey is primarily for retail or specialty pharmacy. If you're an owner of one of those, you should have received an email and survey link this week. Please take the time to complete this survey as soon as possible.

Administration releases strategy
to address opioid crisis

Yesterday, the Office of National Drug Control Policy released the National Drug Control Strategy (“Strategy”), establishing a comprehensive approach to prevent drug abuse, promote treatment, and reduce the availability of illicit drugs. The Strategy recommends utilizing medication-assisted treatment (“MAT”) and counseling as a means to promote long-term recovery, services where the pharmacist’s role could be enhanced. The Administration also suggests expanding access to naloxone by allowing dispensing under a standing physician’s order and developing nonprescription naloxone.

In addition, the Strategy states the importance of improving the effectiveness of prescription drug monitoring plans (“PDMP”) by enhancing integration and data-sharing, as well as encouraging mandatory PDMP checks. Further, the Administration recommends expanding the Drug Enforcement Administration (“DEA”)’s twice-yearly drug Take-Back Day by allowing more registered collectors and disposal sites to support prevention efforts. As a community pharmacist, you can utilize NCPA’s prescription disposal program, Dispose My Meds^™, to help your patients safely dispose of unused and expired medications. The Strategy encourages those on the front lines of the opioid crisis, such as community pharmacists, to use all available tools and resources to address their community’s needs.

Learn more on CMS’ new drug controls

On Jan. 1, CMS adopted new strategies to help Medicare Part D sponsors prevent and combat opioid overuse. These include additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. CMS has created a list of frequently asked questions about the new strategies. Get detailed information about the program here.

NCPA staffer presents on AMA panel

SVP Communications and External Affairs Scott Brunner, CAE, was a panelist at the American Medical Association’s Council on Medical Service discussion on drug pricing this past Monday. Brunner specifically discussed the impact of PBMs and Pharmacy DIR fees on community pharmacies. The panel was convened to assist AMA in determining policy positions on a number of issues impacting drug pricing.

NCPA provides federal and state legislative update in Iowa

This week, Vice President of Federal and State Government Affairs, Anne Cassity, provided a legislative update on state and federal matters to the Iowa Pharmacy Association. Topics included reforms to pharmacy payments in Medicaid and DIR. The update was given in conjunction with the Association’s “2019 Legislative Day” in Des Moines.

NCPA state legislative activity update – Medicaid reform

NPCA tracks state legislation related to our top three state priorities: Medicaid reform, scope of practice and compensation for services, and PBM reform and regulation. Attached is a report of bills that have been introduced so far this session specifically dealing with Medicaid managed care reform. You can access the individual bill language and basic information on the bill by clicking on the bill numbers in the report here.

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.