Pharmacy DIR needs to be addressed
in Senate Finance Committee legislation

The Senate Finance Committee is expected to mark-up legislation addressing prescription drug pricing on June 19. If you are represented by a member of this committee (list of members and contact information is here) call and urge them to address pharmacy DIR fees in this legislation.

Some important points to mention when you call:

• Nationally, pharmacy DIR fees have increased 45,000% since 2010
• Pharmacy DIR fees continue to be unpredictable for pharmacies
• Pharmacy DIR fees force patients to the coverage gap prematurely
• Pharmacy DIR fees must be expeditiously addressed by Congress given the Trump administration’s failure to act

NCPAs DIR infographics may also be helpful.

Senate letter to President on Pharmacy DIR closing;
House letter currently circulating

This week a bipartisan Senate letter to President Trump expressing disappointment that the administration failed to act on pharmacy DIR fees closed. The letter was led by pharmacy champions, Sens. Shelley Moore Capito (R-W.Va.) and Jon Tester (D-Mont.). A similar letter, led by Reps. Peter Welch (D-Vt.), Vicente Gonzalez (D-Texas), Buddy Carter (R-Ga.) and Morgan Griffith (R-Va.), is currently circulating in the House of Representatives. Click here to email your Representative to encourage them to add their name to this letter to demonstrate broad bipartisan disappointment at the administration. The deadline for Representatives to sign on is Thursday, June 13.

NCPA provides recommendations
to Senate HELP Committee
on draft health legislation

This week, NCPA submitted recommendations to the Senate HELP Committee on the Lower Health Care Costs Act of 2019, bipartisan discussion draft legislation to reduce health care costs. In its comments, NCPA supported provisions that would create PBM reporting requirements and provided examples on how that could work. Moreover, NCPA generally supported language that would prohibit spread pricing by PBMs, but cautioned more safeguards were required to prevent pharmacy clawbacks. The HELP Committee is expected to mark-up the final bill at the end of June.

NCPA comments on Energy and Commerce,
Ways and Means joint Medicare proposal

This week, NCPA submitted comments to bipartisan draft legislation from House Ways and Means Committee Chairman Rich Neal (D-Mass.) and Energy and Commerce Committee Chairman Frank Pallone (D-N.J.), along with Ranking Members Kevin Brady (R-Texas) and Greg Walden (R-Ore.). The draft legislation seeks to improve the Medicare Part D prescription drug program for beneficiaries and taxpayers alike. Specifically, the draft would create an out-of-pocket maximum on prescription drugs costs for Medicare beneficiaries in Part D based on the current catastrophic threshold. The draft would also right-size and modernize the incentive structure for Part D plans to better manage costs by reducing the government’s share of the catastrophic coverage from 80 percent to 20 percent over four years. NCPA expressed concerns that the proposal as written could lead to PBMs further squeezing pharmacies to recoup lost revenue and asked the committee to consider address pharmacy DIR fees and consider the creation of pharmacy specific quality measures.

July 4 Congressional recess fast approaching,
host your member of Congress for a pharmacy visit

The July 4 in-district work period is fast approaching. Congress will be away from Washington from June 28-July 8. Schedules are coming together so if you have not done so, extend an invitation to your legislator to visit your pharmacy or schedule a group meeting with multiple community pharmacists with legislators and discuss priority issues. These carry extra value if your legislator is new to Congress so you can familiarize them with community pharmacy and our issues or if they are a member of the Energy and Commerce or Ways and Means health subcommittees, the starting points for much of community pharmacy’s legislation in the House. 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.

Only days remaining to take advantage
of NCPA Annual Convention flash sale

There are only a few days remaining to take advantage of the NCPA Annual Convention flash sale, which ends on June 13. If you have not done so, make sure you register for the NCPA 2019 Annual Convention before the deadline to take advantage of the flash sale discount. Save $100 on Convention registration using code FLASH100. Fine print: This rate is for owner/managers and staff pharmacists ONLY. Here's a sneak peek at the preliminary Convention brochure. See you Oct. 26-29, in San Diego!

New York report recommends
legislative action against PBM practices

The New York Senate Committee on Investigations and Government Operations completed an investigation into PBM practices and their impact on rising drug prices and declining patient access. The committee found that "the consolidation and vertical integration of PBMs has contributed to skyrocketing list prices and declining patient access" and "PBMs often employ controversial utilization and management tools to generate revenue for themselves in a way that is detrimental to health plan sponsors, patients, and pharmacies." The committee concluded that a lack of transparency, oversight, and accountability enables PBMs "to engage in anticompetitive practices at the detriment of consumers and pharmacists across New York State," and recommended action for the legislature to take.

To better understand how PBMs affect independent and community pharmacies, the committee made multiple site visits to pharmacies and relied on input from the Pharmacists Society of the State of New York.

NCPA Members talk community pharmacy issues with SBA

As part of NCPA's ongoing advocacy efforts with the SBA's Office of Advocacy, members are speaking at regional regulatory reform roundtable discussions held around the country. Pharmacy owner Justin Wilson testified in Oklahoma City last month. This week, pharmacy owner Natalie Bari and pharmacist Brandon Cooper represented community pharmacy at a Jonesboro, Ark., roundtable, and Robert Dozier, executive director of the Mississippi Independent Pharmacies Association, testified at a Jackson roundtable. Testimony has focused on the need for a small business impact analysis on the proposed rule to assess manufacturer rebate at the point of sale.

Several pharmacy bills signed into law in Louisiana

This week, Louisiana Governor John Bel Edwards (D) signed the following pharmacy bills into law. These bills were sponsored by Senator Fred Mills (R) and Representative Bernard LeBas (D) who are both pharmacists.

• Louisiana SB 41, introduced by Sen. Fred Mills, is a PBM reform bill that requires PBM licensure, strengthens and expands current MAC laws, and prohibits spread pricing by PBMs without prior notice to the insurer. It also gives the board of pharmacy oversight authority.
• Louisiana SB 239, introduced by Sen. Fred Mills, gives the Louisiana Department of Health greater oversight authority over the Medicaid prescription drug benefit program. The bill would permit the Department to carve the drug benefit out of the Medicaid managed care program. Even if the Department does not carve the benefit out, the bill would increase transparency by prohibiting spread pricing, prevent PBM conflicts of interest by limiting patient steering, and increase patient access to pharmacy services by establishing “any willing pharmacist” standards for the Medicaid managed care program
• Louisiana HB 242, introduced by Rep. Bernard LeBas, prohibits PBMs or health plans from assessing any fees that are not determined at the point of sale.
• Louisiana HB 433, introduced by Rep. Bernard LeBas, allows pharmacists to refuse to fill a prescription if the reimbursement is less than the acquisition cost. In addition, the legislation prohibits a PBM from penalizing or canceling a contract with the pharmacy should it refuse to fill the prescription.
• Louisiana HB 538, introduced by Rep. Bernard LeBas, limits audits and requires that audits must be done by or in consultation with a pharmacist licensed in Louisiana.

Oregon PBM bill recommended out of Senate committee

The Oregon Senate Health Care Committee recommended the passage of HB 2185, which strengthens existing reimbursement transparency provisions, limits retroactive claim adjustments, and preserves pharmacy delivery services.

Connecticut unanimously passes clawback legislation

The Connecticut legislature unanimously passed CT Bill 7363, legislation that eliminates retroactive claim reductions or claw-backs. The bill now awaits the signature of Governor Ned Lamont (D).

NCPA staff presents on track-and-trace requirements
in front of LTC pharmacies

This Tuesday, NCPA’s Kala Shankle, Director of Policy and Regulatory Affairs, presented at the Integra User Conference in Seattle, Washington on supply chain issues important to LTC pharmacies. Of note, the presentation focused on upcoming requirements under the Drug Supply Chain Security Act (DSCSA) and recent changes to an EPA rule governing the disposal of hazardous waste pharmaceuticals.

NCPA supports FDA’s Exploration
of Insulin Biosimilars Market

NCPA, along with NACDS and APhA, submitted joint comments to the FDA after its hearing on “The Future of Insulin Biosimilars: Increasing Access and Facilitating the Efficient Development of Biosimilar and Interchangeable Insulin Products.” Our organizations expressed support of this effort to combat high insulin prices, as many patients (such as those without insurance or individuals with high deductible plans) find themselves in a position of being unable to afford this life saving medication. We also encouraged the FDA to adopt naming practices for insulin products that are consistent with FDA’s naming practices for small molecule drugs, stating that biosimilar versions of insulin products should share the same nonproprietary name as their reference products to inspire confidence in biosimilar insulin.

NCPA state legislative activity update

NCPA tracks state legislation related to our top three state priorities: Medicaid reform, scope of practice and compensation for services, and PBM reform and regulation. Linked below are a report of 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 attached report. Bills that have moved this week are listed at the top in the “Recently Updated” section.

Medicaid Reform Legislation

Scope of Practice Legislation

PBM Reform Legislation

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.