Michigan joins growing list of states addressing
pharmacy payments in Medicaid Managed Care
This week, Michigan’s DHHS posted a notice of policy change that would transition Michigan’s Medicaid Managed Care (MMC) drug benefit to Medicaid FSS effective December 1, 2019. This policy change replicates what West Virginia did last year, a move which saved the state over $50 million. Comments on the proposed policy are due Nov 4th where NCPA will be submitting comments. Michigan is the latest state to address MMC reform, which has picked up steam over the last several years and has increased its momentum in 2019. In just in the last few months, 11 states have passed legislation or regulations in the MMC reform area, everything from increased transparency to prohibitions on spread pricing to Medicaid fee-for-service reimbursement floors. CMS has jumped on the MMC reform bandwagon too, issuing guidance prohibiting spread pricing. The U.S. Senate Finance Committee has also recognized the need for reform by including major Medicaid reform provisions in their drug pricing package, S. 2543. NCPA will host a Medicaid managed care reform advocacy CE at the NCPA 2019 Annual Convention in San Diego, Oct. 26-29. This is a great opportunity to get more insight on Medicaid managed care reform advocacy efforts and learn how you can affect change in your state. Here is a summary of reforms NCPA has been working on with our state partners.
President Trump issues Executive Order on Medicare
This week, President Trump issued an Executive Order addressing Medicare. The EO directs HHS Sec. Alex Azar to propose regulatory changes and take administrative action within a year that would further the implementation of value-based payment models, improve beneficiary access to providers, and reduce regulatory burdens on providers. Specific provisions of the order require the Secretary to take administrative actions to provide beneficiaries with more diverse and affordable plan options and to propose eliminating regulations that are more stringent than applicable Federal or State laws require and that limit professionals from practicing at the top of their profession.
Legal analysis navigates state PBM laws
The National Academy for State Health Policy released a brief that analyzes legal challenges to state drug pricing laws, including PBM reforms. The brief discusses various PBM model laws, including the NCOIL model, which NCPA and other stakeholders worked so hard to get adopted. When discussing ERISA, the brief mentions the lack of uniformity among court decisions and recommends that states not hesitate to adopt PBM regulations. This document is a helpful tool to use with lawmakers who have concerns about potential ERISA lawsuits.
NCPA asks Congress to urge DEA
to revisit Nurse Agency in LTCFs
NCPA joined the American Society of Consultant Pharmacists and other long-term care (LTC) stakeholders in a letter to Senator Sheldon Whitehouse (D-R.I.) expressing concern with the DEA interpretation of who can be an agent of a prescribing practitioner and how that authority can be delegated. In October 2010, the DEA issued a statement of policy, which states that controlled substance prescriptions can only be communicated by the health care provider, an employee of the health care provider, or an agent via a written agreement. In this stakeholder letter, our organizations asked Congress to urge the DEA to create an additional statement of policy that would allow nurse agency in the LTC facility setting to be determined at the discretion of the individual facility. If nurses in this setting could serve as the agents of prescribers for controlled substances, the improved communication process would help residents of LTC facilities receive appropriate pain management in a timely manner.
NCPA supports DMEPOS non-competitive bidding area relief
NCPA joined stakeholders in signing onto a letter in support of H.R. 2271 – Protecting Home Oxygen and Medical Equipment Access Act of 2019, introduced by Reps. Cathy McMorris Rogers (R-Wash.) and David Loebsack (D-Iowa). The bill aims to provide additional relief for Durable Medical Equipment (DME) non-competitive bidding areas and address the problems with the oxygen budget neutrality requirement in the Medicare program.
NCPA talks track-and-trace at wholesaler show
This week, Kala Shankle, NCPA Director of Policy and Regulatory Affairs, presented to an audience of community pharmacists at the Mutual Drug Company’s show in Raleigh, N.C. The presentation focused on what community pharmacists need to know regarding the current and future requirements under the Drug Supply Chain Security Act (“track-and-trace”) law. NCPA will also be presenting on the topic at the NCPA 2019 Annual Convention at the end of this month.
FDA moves to establish information-sharing system
in anticipation of MOU
This week, FDA awarded a grant to the National Association of Boards of Pharmacy to establish an information-sharing system to help facilitate states’ collection and sharing of data on interstate distribution of compounded drugs. FDA’s intent with this three-year pilot project is to reduce any burdens associated with collecting and sharing information on interstate distribution that would be required by the memorandum of understanding (MOU). The FDA plans to finalize the MOU later this year. NCPA continues to actively engage with the FDA on the burdens associated with the MOU that would impede patient access to medically necessary compounded products.
NAIC PBM subgroup continues information gathering calls
The National Association of Insurance Commissioners’ PBM Regulatory Issues Subgroup held another information gathering call this week. During the call, the subgroup heard from insurance department staff from Arkansas, Kentucky, Montana, New Mexico, and Oregon about those states’ PBM laws. A frequent concern over PBM legislation is the financial impact on the state. Presenters discussed the fiscal impact (or lack thereof) of the PBM laws on their respective agencies. For the most part, PBM legislation has not required the hiring of additional employees, and the additional duties could be shared among existing staff.
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 reports 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.
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.