NCPA Advocacy Update

Week ending March 22

Author: APCI Staff/Monday, March 25, 2019/Categories: Legislative Affairs

NCPA Congressional Pharmacy Fly-in
is less than 3 weeks away

NCPA’s Congressional Pharmacy Fly-in is less than 3 weeks away (April 10-11) and more of the programming is being finalized. If you have not yet registered, don’t miss out on the opportunity to hear from two pharmacy champions, Reps. Doug Collins (R-Ga.) and Peter Welch (D-Vt.) who have both their participation at the Congressional Pharmacy Fly-in. 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 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 DIR fees and potential changes to Medicaid. 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. Due to the schedule, we suggest requesting house visits for after 1:00 on April 10 and Senate visits for April 11. Go to 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.

Note: For those who will be arriving for the fly-in early, NCPA PAC will be hosting a breakfast fundraiser for Sen. Joni Ernst (R-Iowa) on Tuesday, April 9 at 7:15am at the Alexandria Hilton, and we cordially invite you to attend. Click here to read the invitation for more information.


Kentucky AG launches investigation of PBMs

This week, Kentucky Attorney General Andy Beshear launched an investigation into allegations that PBMs have overcharged state health insurance programs for drugs and discriminated against independent pharmacies. In a statement, Beshear said he is seeking details on how PBMs have determined, billed and paid drug reimbursement rates over the past five years in Kentucky. “PBMs were originally established to help companies and government programs better manage pharmacy costs but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information,” Beshear said. A report released last month by the state Medicaid agency indicated that two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs.


5 PBMs to testify before Senate Finance Committee on April 9

The Senate Finance Committee invited representatives from five PBMs to testify before the committee on April 9. The hearing will focus on prescription drug pricing and the PBM industry. Those testifying are representatives for Humana, CVS, Cigna, OptumRx and Prime Therapeutics. The committee previously heard from executives representing manufacturers on this subject in February. NCPA is working with several offices of committee members to submit questions for the record.


Senior Democrats visit community pharmacies

This week, several senior Democrats visited independent community pharmacies. Energy and Commerce Committee chairman, Rep. Frank Pallone (D-N.J.) visited Boyt Drugs in Metuchen where he held a press event to discuss his proposals to lower prescription drug prices. Sen. Ron Wyden (D-Ore.), the ranking member of the Senate Finance Committee held a similar press event at Brooklyn Pharmacy in Portland. Additionally, Rep. Lloyd Doggett (D-Texas), chairman of the Ways and Means Health Subcommittee visited Carvajal Pharmacy in San Antonio where he was presented information on key pharmacy related legislation, H.R. 803, H.R. 1034, and H.R. 1035, of which he seemed supportive. Finally, Sen. Elizabeth Warren (D-Mass.), a candidate for the Democratic Presidential nomination, stopped by Carter Drug Co. in Selma, Ala. on a visit to the state.


NCPA continues to engage with industry
on HHS’ plan to operationalize a world without rebates
and prepares “Minimum Requirements” document
for comments

This Thursday, NCPA staff Ronna Hauser and Kala Shankle attended an industry-wide event on operationalizing a world without rebates, a concept recently proposed in an HHS OIG proposed rule. The proposed rule seeks to prohibit kickbacks given to PBM’s and instead, create a new safe harbor that allows for point-of-sale price reductions from manufacturers to plans. The event served as a timely gathering to hear outside groups speak publicly on the implications of the proposed rule.

Internally, NCPA has spent a great deal of time and effort analyzing and speaking to stakeholders on the implications of this proposed rule for community pharmacies, including but not limited to potential legal, commercial, financial, and regulatory impacts. NCPA has also been working closely with industry veterans and consultants to prepare NCPA’s comments, which will serve as an important voice for community pharmacies role in a world without rebates.

To guide NCPA’s comments to HHS, NCPA has prepared the “Minimum Requirements” for NCPA to provide support for finalization of the proposed rule. NCPA encourages your organization to utilize these Minimum Requirements in your own comments to the proposed rule.

Comments are due April 8, 2019.


NCOIL committee asks Congress
to create ERISA waivers

At the spring meeting of the National Conference of Insurance Legislators, the NCOIL Health Insurance and Long-Term Care Committee passed a resolution urging Congress to create an ERISA waiver program to provide some meaningful oversight of health plans/PBMs at the state level. This would address one of the arguments PBMs use when challenging state laws that establish PBM oversight and transparency.


MedPAC releases annual report to Congress

Last week, the Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress regarding the status of the Medicare Program, of which chapter 14 discusses the Medicare prescription drug program (Part D). Of note, the report discussed pharmacy networks and post-sale fees (aka pharmacy DIR or pharmacy price concessions), stating that plans can include network contract terms that try to achieve exclusivity through what MedPAC calls “terms that have largely led to post-sale payments from pharmacies to plans.” MedPAC honed in on specific types of post-sale payments utilized today, including payments based on preferred cost-sharing pharmacy, periodic payment reconciliations related to drug reimbursement rates, or performance-based fees that are assessed on quality measures. MedPAC further described the difficulty for pharmacies to be able to predict their ultimate amount of reimbursement from plans due to these post-sale payments. In line with what NCPA has already relayed to CMS and CMS has also stated in its recent proposed rule on pharmacy DIR, the report states that pharmacy price concessions and fees grew dramatically between 2013 and 2017, from $229 million to $4 billion. While MedPAC did not offer any suggestions in the status report to fix DIR, it is clear that MedPAC is aware of the dramatic increase of pharmacy DIR and its drastic impact on pharmacies and patients. You can read the full report on Medicare Part D here: http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch14_sec.pdf?sfvrsn=0.


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. The deadline to complete is Tuesday, March 26.


NCPA state legislative activity update

Click the links to view a report of bills that have been introduced so far this session specifically dealing with NCPA’s top three state priorities: Medicaid managed care payment reform, scope of practice and compensation for services, and PBM reform and regulation. You can access the individual bill language and basic information on the bill by clicking on the bill numbers in the attached 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.

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