Senate Finance Committee Adds Pharmacy DIR Reform
to Drug Pricing Package After NCPA Sends Letters

Today, Senate Finance Committee Chairman Charles Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) released an updated version of S. 2543, the Prescription Drug Pricing Reduction Act, their bipartisan drug pricing legislation. In a huge win for community pharmacies and patients, the updated draft will require price concessions to be included in the negotiated price at point of sale for Medicare Part D starting Jan 1, 2022. The bill would prohibit plans and PBMs from retroactive recoupment but would allow positive post point of sale incentive payments for pharmacies. Additionally, the bill would move up the implementation of standardized pharmacy quality measures to 2022. NCPA and its members have led the charge and worked tirelessly on securing DIR reform for years. On Monday, NCPA sent letters to key committees in the House and Senate and to the Trump administration making the case for the very changes to the bill that were announced today. The letters urged for the enactment of meaningful reform to address DIR clawbacks and lower patient costs at the pharmacy counter. As previously drafted, NCPA was concerned that standardized quality measures alone without clawback reform would leave a loophole for the PBMs to exacerbate the current DIR problem. While the path to passage of the bill is not certain, NCPA looks forward to continuing to work with Congress to ensure pharmacies get relief from DIR fees and patients see the benefit of lower out of pocket costs.

House Expected to Vote on Drug Pricing Legislation Next Week

This week, Speaker Nancy Pelosi (D-Calif.), Majority Leader Steny Hoyer (D-Md.), Energy & Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), Ways & Means Committee Chairman Richard E. Neal (D-Mass.) and Education & Labor Committee Chairman Bobby Scott (D-Va.) announced that the House of Representatives will pass the H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act next week. In their statement, the House Democrat leaders said, “We have now received enough guidance from CBO to bring the Lower Drug Costs Now Act to the Floor and to reinvest its savings in one of the most transformational improvements to Medicare since its creation.” The bulk of the bill addresses Medicare price negotiations with pharmaceutical manufacturers. While H.R. 3 contains language to standardize pharmacy quality metrics, it does not address pharmacy DIR clawback reform. As NCPA laid out in its letter on Monday, we believe that the current language standardizing quality metrics without requiring all pharmacy DIR be assessed at the point of sale leaves a loophole for the PBMs that could exacerbate the current problem. Senate Majority Leader Mitch McConnell (R-Ky.) has repeatedly stated that the House drug pricing package is a non-starter and would not be considered in the Senate. NCPA will continue to work with pharmacy champions and the committees of jurisdiction in both the House and Senate on inclusion of meaningful DIR reform in bipartisan drug pricing legislation so that small business community pharmacies get relief from DIR fees and their patients get relief from high drug costs.

Federal Government Disagrees with Eighth Circuit
on Arkansas PBM Case

The United States Solicitor General filed an amicus curiae brief on behalf of the federal government arguing that the Supreme Court should review the Eighth Circuit’s holding that ERISA preempts State laws that regulate PBM-pharmacy reimbursements. In the view of the federal government, the Eighth Circuit’s ruling is “incorrect” and “contrary to [the Supreme] Court’s precedent and the decisions of other courts of appeals.” Further, in the brief, the federal government urges the Supreme Court to review the Eighth Circuit’s incorrect ruling.

The opinion by the Office of the U.S. Solicitor General (OSG) is important because a favorable review by the OSG greatly increases the likelihood the U.S. Supreme Court will agree to grant cert or hear a particular case. NCPA has been active in this effort from the beginning and commends the Arkansas Pharmacists Association for its work. NCPA’s one pager on the opinion is available here.

Collin County, Texas Commissioners Find
Mail Order Prescriptions to be More Expensive

Collin County, Texas had long incentivized their employees to use mail-order, and even limited 90-day fills to mail order. After extensive analysis, they found that most prescription drugs were more expensive under mail order, $29.09 more expensive per script. That is before considering that the county paid for the third month’s fill and delivery fees. Commissioners recently changed their policy so county employees could get 90-day fills at retail and removed all incentives for employees to use mail order. The county employees now have a choice. The video of the Collin County Commissioners Court healthcare discussion on employee benefits for 2020 can be seen here. Please share with employers-government and the private sector. Thank you to NCPA member John Hickman, owner of Dyer Drug Store in Farmersville, Texas for bringing this issue to our attention.

NCPA Submits Comments to California
PBM Reporting Task Force

NCPA submitted comments to the California PBM Reporting Task Force. The task force must recommend data points to be reported by PBMs to the state so that the state can better control drug prices. NCPA focused its comments on the importance of requiring the reporting of manufacturer rebates, spread pricing, and retroactive claim adjustments and fees.

NCPA Asks FDA to Reconsider Processes
and Substances Under 503A

This week, NCPA submitted comments to FDA on its Amendments to the List of Bulk Drug Substances that can be Used to Compound Drug Products under Section 503A of the Federal Food, Drug, and Cosmetic Act (503A Proposed Rule). We recommended that FDA revise its process it uses to develop the list of bulk drug substances as there is a lack of clear guidance. Further, we supported the addition of six substances: 7-Keto Dehydroepiandrosterone (DHEA), Acetyl-L-Carnitine (ALC), Chondroitin Sulfate, Chrysin, Deoxy-D-Glucose, and Kojic Acid. NCPA will continue to engage with FDA to ensure continued access to medically necessary compounded medications.

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. Click each issue for 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.

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