Additional Bipartisan Congressional support emerges
for HHS’ DIR proposal
This week, Reps. Doug Collins (R-Ga.) and Vicente Gonzalez (D-Texas) as well as members of the Georgia House delegation sent letters to HHS Secretary Azar, in 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. The letter from Collins and Gonzalez, who are the lead sponsors of H.R. 1034, the Phair Pricing Act, noted the similarities of the proposed rule and their bill. The Georgia delegation letter was led by Rep. Buddy Carter (R-Ga.) and was co-signed by Reps. Rick Allen (R-Ga.), Sanford Bishop (D-Ga.), Drew Ferguson (R-Ga.), Jody Hice (R-Ga.), Barry Loudermilk (R-Ga.), Austin Scott (R-Ga.) and David Scott (D-Ga.).
PhRMA executives to testify before
Senate Finance Committee next week
Executives from seven pharmaceutical manufacturers will testify about drug pricing practices before the Senate Finance Committee on Tuesday, February 26th. The seven companies scheduled to be represented are AbbVie, AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Merck, Pfizer and Sanofi. Calling the pace of drug price increases "unsustainable," Sen. Charles Grassley (R-Iowa), the committee's chairman, said in a statement that he wants pharmaceutical executives to explain how they price these treatments, "whether the status quo is unacceptable" and what can be done to lower costs.
Register now to attend
2019 Congressional Pharmacy Fly-in
NCPA’s Congressional Pharmacy Fly-in (April 10-11) is quickly approaching, and the programming is taking shape. Two pharmacy champions, Reps. Doug Collins (R-Ga.) and Peter Welch (D-Vt.) have confirmed their participation. This is also an opportunity to make your voice heard in meetings with your legislators or their key staff members. With a bipartisan desire in Congress to tackle the high cost of prescription drugs and pro-pharmacy legislation addressing issues such as pharmacy DIR pending in Congress, your interests must be represented! Your voice carries additional weight and your attendance is even more critical if you are represented by a member of the Energy and Commerce or Ways and Means health subcommittees, which have jurisdiction over most pharmacy legislation. Plus, you can earn up to 3.5 hours of CE credit at briefings on a range of issues, including pharmacy DIR fees, the congressional agenda for 2019 and an update on NCPA’s advocacy efforts. Registration is open, so don’t delay, register now online or by calling 1-800-544-7447. If you’ve already registered, don’t forget to schedule your hill visits. Visit NCPA’s Legislative Action Center to look up the contact information for your legislators. Contact Michael Rule at michael.rule@ncpanet.org if you have any questions.
Kentucky Medicaid finds large PBM spread,
recommends reforms to managed care program
The Kentucky Department for Medicaid Services released a report showing that PBMs pocket $123.5 million annually through the use of spread pricing in the state’s Medicaid managed care program. In the report, the Department recognized that their analysis did not include revenue obtained through retroactive pharmacy fees, including in-network fees, transmission fees, and GER fees. Therefore, the amount PBMs pocket could be much higher. These findings led the Department to make a number of recommendations to overhaul the prescription drug benefit, including eliminating spread pricing and implementing a reimbursement floor equal to fee-for-service rates. The report is the result of Senate Bill 5 (2018), which sought to facilitate “transparency and to better assess contracts between entities providing Medicaid pharmacy benefits with public dollars.”
Ohio seeking $16 million repayment from OptumRx
PBMs’ fleecing of taxpayers is not limited to Medicaid managed care programs. According to a Columbus Dispatch article, Ohio’s attorney general is seeking $16 million dollars from OptumRx for overcharging the state’s workers’ compensation program. After investigating Optum’s performance, the Bureau of Workers’ Compensation “discovered we were being hosed.” According to the article, “[m]ore such moves are expected against pharmacy benefit managers administering public dollars.”
NCPA issue brief highlights potential cost savings
through reforming Medicaid Managed Care
As a reminder, NCPA recently created a new issue brief highlighting different variations of Medicaid Managed Care (MMC) reform. Additionally, the 1-pager includes states who have implemented specific reforms and studies highlighting potential savings. This has been updated to include the findings from Kentucky. Some of the reforms could result in potential cost savings to states. Reforming the pharmacy payment model in MMC is one of NCPA’s top priorities, and the issue brief addresses three possible solutions. Each solution would increase transparency and potentially save states tens of millions of dollars. The brief will be helpful in demonstrating these facts to legislators.
Make sure your data is included
in the retail/specialty cost of dispense survey
If you have not yet done so, please complete the retail/specialty cost of dispensing survey. Your responses will assist in estimating costs of dispensing nationally and in each state. These estimates will then be used to inform policy questions related to reimbursing costs of dispensing across the US. It’s your opportunity to provide information on costs of dispensing and underlying factors, for consideration by Medicaid agencies and other payers. Findings from prior surveys have been used by Medicaid agencies to determine their cost of dispensing rates. While, the survey is likely to take a few hours to complete and possibly more, depending on the information system and number of pharmacies, the data you provide is immensely important. You may complete the survey by paper, online, or through a spreadsheet for multiple pharmacies at once. To complete the survey online, please access the survey here.
NCPA applauds efforts to fully repeal the “death” tax
This week, NCPA was one of the more than 150 associations to sign onto a letter, led by the Family Business Coalition, to Sen. John Thune (R-S.D.) and Rep. Jason Smith (R-Mo.) who are the lead sponsors of the Death Tax Repeal Act. The letter thanks both legislators for their leadership on this issue and highlights the benefits to small businesses.
NCPA comments on ACA Exchange Rule proposals
This week, NCPA submitted comments to CMS on the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020 Proposed Rule. Through this proposed rule, CMS works to further its effort to increase cost-sharing transparency for consumers and asks industry whether to pursue therapeutic substitution, as well as whether to not count brand drug manufacturer coupons toward a patient’s annual cost-sharing limit when there is a generic equivalent available. NCPA applauded CMS’ effort to increase cost-sharing transparency for consumers and also recommended that CMS encourage states to choose EHB-benchmark plans that recognize pharmacist-provided services. Further, we supported CMS’ proposal to pursue therapeutic substitution by recognizing the community pharmacist’s role in this service. Lastly, NCPA cautioned against any cost-sharing proposals that would lower adherence and shift costs to patients.
NCPA educates community health centers
on pharmacy DIR
This week, NCPA’s Kala Shankle, Director of Policy and Regulatory Affairs, addressed the National Association of Community Health Centers (NACHC) in a webinar on the implications of pharmacy DIR fees in Medicare Part D for 340B contract pharmacies. The webinar focused on the history of DIR, problems with DIR in the community pharmacy setting, and NCPA’s recent advocacy efforts on the issue. Overall, the webinar served as a ripe opportunity to educate community health centers on community pharmacies’ experience with DIR while participating as a 340B contract pharmacy in the hopes to foster a better relationship between these community based providers.
NCPA sends letters of support
for New Mexico’s PBM reform bills
NCPA submitted letters of support for two New Mexico bills that would reign in abusive PBM practices. SB 394 would protect pharmacists by preventing PBMs from recouping funds during pharmacy audits for arbitrary reasons, such as harmless clerical errors. SB 415 would bring more transparency to PBM reimbursement methodologies by limiting retroactive fees and claim reductions. Both bills have passed out of their first committee.
NCPA state legislative activity update
NCPA tracks state legislation related to our top three state priorities: Medicaid managed care payment reform, scope of practice and compensation for services, and PBM reform and regulation. The reports cover bills that have been introduced so far this session specifically dealing with these three issue areas. You can access the individual bill language and basic information on the bill by clicking on the bill numbers in the reports.
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.