Sec. Azar and Rep. Collins energize
community pharmacists to storm the hill

During this week’s NCPA Congressional Pharmacy Fly-in, HHS Sec. Alex Azar energized attendees with rousing remarks. Azar brought the crowd to their feet and received a standing ovation for his pledge to take on the big special interests who manipulate the prescription drug marketplace at the expense of independent pharmacists and their patients. Azar also remarked on pharmacy DIR fees and mentioned a forthcoming rule that could address them. He also noted that community pharmacists are the most accessible health care providers and can play an instrumental role in the health care delivery system.

Attendees were also treated to fiery comments from community pharmacy champion Rep. Doug Collins (R-Ga.) who opened the program and noted that the tide had turned in the battle against the PBMs and that they are now on the defensive after being grilled in Congressional hearings. Collins further noted they are PBMs are now compelled to spend money on PR to boost their image, "but can't explain away DIR fees that average $82,000 per pharmacy practice."

After being energized by these remarks, fly-in attendees stormed Capitol Hill to meet with their legislators and key staff members. In total, attendees carried the message that community pharmacists are part of the solution to lower health care costs and PBMs are part of the problem to more than 260 Congressional offices.

PBMs scrutinized at Senate Finance Committee hearing

This week, the Senate Finance Committee held its third hearing on drug pricing, focusing on PBM practices, such as rebates from drug manufacturers to PBMs, transparency of rebate and pricing negotiations, and industry practices that could help or hurt affordability of drugs for Medicare and Medicaid beneficiaries and other consumers. Committee Chairman Chuck Grassley (R-Iowa) emphasized his continued support for private-sector negotiations while expressing concern that practices in the drug supply chain may not benefit patients. Chairman Grassley, Ranking Member Ron Wyden (D-Ore.) and Committee Members on both sides of the aisle discussed the need for more transparency of price negotiations between PBMs and drug manufacturers. Chairman Grassley indicated he plans to work on legislation with Ranking Member Wyden and other Senators, focusing on protecting Medicare and Medicaid patients. Ranking Member Wyden highlighted his request with Chairman Grassley seeking an Office of Inspector General (OIG) investigation into PBM practices paying pharmacies a set price while charging Medicaid and other health care payers more for the same prescription. PBM industry witnesses were asked about pricing practices, whether these activities artificially increase costs for consumers, and options to enhance transparency. Among many tough questions from Senators, community pharmacy champion Sen. James Lankford (R-Okla.) grilled the PBM witnesses on pharmacy DIR fees. NCPA thanks Chairman Grassley, Ranking Member Wyden, and all the committee members for holding this important hearing.

PhRMA, PBMs blame each other for insulin price spikes

This week, the House Energy and Commerce Subcommittee on Oversight and Investigations held its second hearing on insulin pricing and featured witnesses from pharmaceutical companies and PBMs. Members of the committee were bipartisan in their criticism of manufacturers and PBMs for their role in rising prices. Meanwhile, the two group of witnesses simply pointed fingers at each other. The manufacturers cast rebates as the root of the problem, and PBMs blamed the high list prices set by manufacturers and the lack of generic insulin. Rep. Jan Schakowsky (D-Ill.) affirmed Congress’s intent to do something about this problem saying, "This is a commitment on the part of the Congress to get drug prices – particularly life-saving life necessities – to get those prices under control. … Your days are numbered."

Sens. Grassley and Wyden request HHS investigation
of PBM spread pricing

This week, Senators Charles Grassley (R-Iowa), Chairman of the Senate Finance Committee and Ron Wyden (D-Ore.), the committee’s Ranking Member, asked the Department of Health and Human Services Office of Inspector General to investigate pharmacy benefit managers over the practice of spread pricing, or reimbursing pharmacies less than what they charge health plans for prescription drugs, in state Medicaid programs. The practice was scrutinized during the committee hearing this week.

Ways and Means Committee advances
NCPA supported Prescription Drug STAR Act

This week, the House Committee on Ways & Means unanimously passed the bipartisan Prescription Drug STAR Act (H.R. 2113) to addresses key issues related to transparency and public reporting of information in order to improve accountability and ensure consumers, purchasers, payers, and taxpayers have a better understanding of this opaque market. NCPA wrote a letter of support for a component of this legislation, which would require the Secretary of Health and Human Services to publicly disclose the aggregate rebates, discounts, and other price concessions achieved by PBMs on a public website, so consumers, employers, and other payers can understand and compare the discounts PBMs receive. NCPA thanks Chairman Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) for advancing the legislation, as well as Reps. Abigail Spanberger (D-Va.), Jodey Arrington (R-Texas), and Brendan Boyle (D-Pa.) who sponsored the PBM transparency provision. NCPA’s support for the legislation was noted in the committee’s announcement of the bill’s mark-up.

Invite your legislator for a visit
during the in-district work period

Members of Congress have left Washington for a two week in-district work period from April 13-28. This is an excellent opportunity to invite legislators to visit your pharmacy or to schedule a group meeting with multiple community pharmacists with legislators and discuss priority issues.

Pharmacy visits and face-to-face meetings are tremendously effective ways to communicate with legislators and to establish yourself as a resource to them as issues arise. Visit NCPA’s pharmacy visits webpage or contact Michael Rule at michael.rule@ncpanet.org for tips on arranging a visit with your legislator.

NCPA submits comments on HHS’ proposed rebate rule

This week, NCPA submitted comments on the Trump Administration proposal to prohibit the use of rebates in contracts between Part D plan sponsors and drug manufacturers. And in his remarks at the NCPA Congressional Pharmacy Fly-In, Sec. Azar said, "we are going to pay close attention to all the input we receive from stakeholders, like you." In our comments we emphasized that while we stand with the administration in its efforts to lower drug prices, a number of "minimum requirements" are needed to eliminate the barriers inhibiting community pharmacists' relationships with patients. These requirements include fixing pharmacy DIR, timely payments, increasing transparency and financial viability, appropriate agency oversight of implementation, protections for small business, and the opportunity for independent community pharmacies to choose their business partners. In addition to NCPA’s comments, 260 comments were submitted by pharmacists through NCPA’s grassroots portal.

NCPA PAC Supports Pharmacy Champion Sen. Joni Ernst

NCPA PAC hosted a fundraising breakfast last week during the NCPA Steering Committee Forum for Senator Joni Ernst (R-Iowa.). With the generous support of NCPA members in attendance were able to raise over $23,000 for the Senator’s reelection efforts. Ernst was kind enough to speak to attendees about legislation on Capitol Hill that affects community pharmacy and held a brief q&a before making her way in to the Senate for another day’s work advocating for community pharmacy.

NCPA PAC Telethon Surges Past Expectations

Results are still being tallied and final results, but NCPA PAC Chairman Steve Giroux, a pharmacy owner from New York, already declared that this week’s volunteer NCPA PAC telethon was a whopping success, so far raising over $111,000 in funds and pledges that will be used to elect candidates who think like you do – pharmacy champions who know what it’s like to run a small business, make a payroll, and deal with red tape. This represents a 26% increase in results year over year. More than 20 pharmacy owners from all over the nation volunteered their time for the telethon, coming to NCPA offices in Alexandria to make calls. “It just proves again that there’s no better fundraiser for the NCPA PAC than a pharmacy owner who has invested and is willing to ask a fellow pharmacy owner to do the same,” said Giroux. “A big, big thank you to those who made calls for us this week, and to those members to rose to the challenge and invested.”

NCPA supports making the small business
pass through deduction permanent

This week, NCPA joined more than 100 business allies in supporting new legislation to make permanent the 20-percent pass-through deduction. S. 1149, the Main Street Certainty Act of 2019, introduced by Sen. Steve Daines (R-Mont.), is the companion bill to H.R. 216, bipartisan legislation introduced by Reps. Jason Smith (R-Mo.) and Henry Cuellar (D-Texas) in the House of Representatives. The new, 20-percent deduction was a key part of the big tax reform bill enacted back in 2017. The deduction was designed to balance out the tax treatment of pass-through businesses with the lower, 21-percent tax rate paid by C corporations. The full letter is available here.

NCPA meets with Small Business Administration

This week NCPA staff met with the Small Business Administration to discuss small business issues impacting community pharmacies. Of focus in the meeting, NCPA discussed the dire need for the pharmacy DIR rule to by finalized by CMS immediately and the small business perspective on OIG’s recently proposed rule to asses manufacturer rebates at the point of sale. NCPA continues to work with the SBA to highlight these issues in our current and future advocacy efforts.

Ohio Medicaid managed care organization fires CVS Caremark

In an effort to increase drug pricing transparency, CareSource, Ohio’s largest Medicaid managed care provider, announced it was firing CVS Caremark as its PBM. An audit of the state’s Medicaid managed care program found PBMs kept over $220 million annually through spread pricing; CVS pocketed $114 million through its contract with CareSource alone. The move will help the MCO comply with Ohio’s new “pass-through” model requirements that were implemented Jan. 1.

National Association of Insurance Commissioners
to draft model PBM bill

Earlier this week, NAIC’s Regulatory Framework Task Force voted to approve a PBM model law. This approval is just the first step-the next step will be drafting the actual model language. NCPA will continue to engage and serve as a resource for NAIC on these efforts.

NCPA hosts state government affairs program

Prior to Wednesday’s Congressional Fly-in, NCPA co-hosted a state legislative update program with the National Alliance of State Pharmacy Associations (NASPA), “What’s Happening in Your Neighborhood and Elsewhere?” to discuss what’s going on in state legislatures throughout the country.

Gottlieb and Abram outline FDA’s compounding priorities

Last week (now former) FDA Commissioner Scott Gottlieb and Deputy Commissioner Anna Abram released a statement addressing the FDA's efforts to continue improving the quality of compounded drugs this year. Gottlieb and Abram indicated that the FDA's compounding priorities for 2019 will include maintaining quality manufacturing and compliance, regulating compounding from bulk drug substances, finalizing their Memorandum of Understanding with the states, clarifying its policies regarding hospital compounding, and continuing to work closely with stakeholders to promote improving the quality of compounded drugs. NCPA will continue to actively engage with the agency on these compounding priorities, including the MOU and various guidances, to ensure compounding pharmacists’ voices are heard.

State Roundup:

Arkansas The legislature passed SB 520. The bill awaits the Governor’s signature and includes the following provisions:

• Prohibits spread pricing.
• Prohibits DIR fees, GERs, and BERs and other aggregate level take it or leave it “clawback” terms from PBMs and health plans that create unfair market conditions and dangerous patient care environments.
• Sets a payment floor for ingredient cost payment to pharmacies that is not less than NADAC or WAC (when no NADAC exists). These are national averages of actual community pharmacy invoice acquisition purchase price values.
• REQUIRES quarterly rebate reporting by PBM to the Arkansas Insurance Department of all rebates and ALL payments from pharmaceutical manufacturers (drug companies) to Pharmacy Benefit Managers, health plans, and pass through to community pharmacies. This data should increase transparency and lead to better rate reviews and policies for the state, as well as potential regulations addressing the patient not benefiting from the practices.
• Closes loopholes on the definition of Maximum Allowable Cost, to include all drugs and all payment methodologies. Example, Means you can appeal AND decline services if paid below cost on not just generic drugs, but all drugs INCLUDING brand, specialty and biologic medications.
• Clarifies in law that Managed Care Medicaid programs and PBMs are regulated by these statutes (and previous PBM licensure laws) and enforceable by the Arkansas Insurance Department.

Louisiana introduced SB 41, which says of PBMs that “there is no other example in the modern history of a field as highly regulated as healthcare where an entity without a medical license and with no relationship to the patient is able to override the medical professionals who are directly treating the patient.” As such, the bill would require PBMs to obtain licenses from the Board of Pharmacy and the Board of Medical Examiners so that the state can regulate PBMs “with the same regulatory scrutiny exercised over other healthcare providers who are integral decision makers in the patient’s treatment and care.”

North Carolina introduced HB 534, which would prohibit PBMs from requiring patients to fill prescriptions at PBM-owned pharmacies, prohibit reimbursement policies that have “the express intent or purpose of driving out competition or financially injuring competitors,” and increase patient access to pharmacy services by implementing “any willing pharmacy” provisions. The bill also includes other provisions that will reign in abusive PBM practices.

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. Bills that have moved this week are listed at the top in the “Recently Updated” section.

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.