New Analysis Blows Lid Off $8.5 Billion PBM Scam
An excellent analysis was published this week by XIL Consulting, which is run by a former Express Scripts executive. The report focuses on how PBMs are manipulating the Medicare Part D system with DIR fees and hurting pharmacies and patients. According to the report, payers and Pharmacy Benefit Managers (PBMs) are profiting from obscure pharmacy fees at a rate in excess of 500% per prescription as compared to the average PBM administration fee by exploiting a loophole in the Medicare Part D program that allows health plans and PBMs to pocket an excessive amount of pharmacy DIR fees rather than offset prescription costs for seniors. Every pharmacist, policymaker and reporter in the country should see this report, and we would very much appreciate you sharing through your social media channels.
Help Community Pharmacy Make its Best Case
to the Supreme Court
In the coming months, the Supreme Court will hear a case focused on state regulation of PBMs in the case of Rutledge v. PCMA. A date for oral arguments has not yet been set, but a decision in the case is expected before June 30. If it comes down in our favor, the decision could significantly empower states to regulate PBMs.
In the latest development, PCMA has hired Seth Waxman, the former Solicitor General of the United States, to represent them. We understand Mr. Waxman charges $4,000/hour for his services and we know PCMA and the PBMs they represent have the resources to cover such a bill. To counter the well-funded opposition, NCPA is seeking to build a coalition of partners to make the best legal arguments. But this also takes resources. If you have not done so, please consider an investment in NCPA's Legislative/Legal Defense Fund (LDF). The LDF can accept both corporate and individual funds, and it supports our entire advocacy operation. This includes attorneys and outside counsel. The better funded the LDF, the more resources we can dedicate to this landmark case and better prepare for the legislative battles in the states once a decision is rendered.
More Information on the case can be found on this summary page. NCPA has dedicated significant staffing and financial resources supporting related issues for over 15 years, with this current Supreme Court case representing the culmination of those efforts. Please help us ensure we have the necessary resources to prevail by investing in the LDF.
NCPA Endorses Legislation to Ban Spread Pricing
in Medicaid Managed Care
This week, NCPA endorsed H.R. 5281, the Drug Price Transparency in Medicaid Act, which would ban the use of spread pricing by pharmacy benefit managers (PBMs) in Medicaid managed care. Currently, PBMs can overbill Medicaid managed care programs, under-reimburse pharmacies for medications dispensed, and retain the difference, which is referred to as the “spread.” Under this proposal, Medicaid managed care PBMs would be required to reimburse pharmacies based on ingredient cost based on data from the National Average Drug Acquisition Cost (NADAC) report and a professional dispensing fee, which must be no less than reimbursement under the fee-for-service program. The bipartisan legislation was introduced by Reps. Buddy Carter (R-Ga.) and Tony Cárdenas (D-Calif.).
DOJ and FTC Propose New Guidelines
to Evaluate Future Mergers Like CVS/Caremark/Aetna
The Department of Justice (DOJ) and Federal Trade Commission (FTC) recently proposed an overhaul of antitrust rules for vertical mergers. A vertical merger is the merger of two companies that operate in the same supply chain but don't directly compete with one another, such as CVS/Caremark/Aetna, Cigna/Express Scripts, and UnitedHealth/Optum Rx. If finalized, the guidelines would replace rules that haven't formally been updated since 1984 despite new thinking about how such deals affect competition. NCPA believes these guidelines need to be stricter and will be submitting comments to that effect. NCPA also has sample comments available for pharmacists who wish to comment prior to the Feb, 26 deadline. These can be submitted throughNCPA’s Legislative Action Center.
NCPA Officer Testifies in Favor of PBM Reform Bill in WI
This week, NCPA’s Fourth Vice-President, Hashim Zaibak testified on behalf of NCPA in support of SB 100 before the Senate Committee on Health and Human Services. The bill would require PBMs to become licensed in the state, limit retroactive claim reductions, prohibit gag clauses/copay clawbacks, and establish pharmacy audit protections. Last week NCPA’s Matt Magner provided similar testimony before the Assembly Committee on Health. Over the past couple of weeks, the Wisconsin State Legislature has heard from dozens of independent pharmacists and patients in support of the PBM regulations. NCPA thanks Pharmacy Society of Wisconsin, Hometown Pharmacies, and all pharmacy advocates for their work on this important bill.
Register Now for the NCPA Congressional Pharmacy Fly-in
Registration for NCPA’s 2020 Congressional Pharmacy Fly-in now open. The Fly-in, which will be held April 21-22, is an opportune time to meet with legislators or their key staff about community pharmacy’s legislative priorities. You'll fly in, spend a few hours with the NCPA Advocacy Center staff, and then have some face time with your members of Congress and/or their staff. It's your chance to tell them how their votes affect your business and the patients you serve.
PQA Endorses Three New Pharmacy Performance Measures
Pharmacy Quality Alliance (PQA) members recently endorsed three new pharmacy performance measures that evaluate adherence for medication treatment of hypertension, cholesterol and HIV.
- Proportion of Days Covered: Renin Angiotensin System Antagonists (Pharmacy)
- Proportion of Days Covered: Statins (Pharmacy)
- Proportion of Days Covered: Antiretroviral Medications (Pharmacy)
Standardized, nationally endorsed measures exist throughout many areas of our healthcare system; however, there is a lack of standardized measures available to assess pharmacy quality. NCPA has long advocated for standardized pharmacy measures to be used in the Part D program and is pleased that PQA is beginning work this quarter to develop additional pharmacy measures that could be used in value-based care models to improve patient health. To inform this work, PQA created a Pharmacy Measure Concept Advisory Group (MCAG), which will be composed of approximately 30 subject matter experts from PQA’s membership, including NCPA staff and members.
FDA Grants Extension on Animal Compounding Comments
FDA extended the comment period for its Draft Guidance for Industry (#256) Compounding Animal Drugs from Bulk Substances until June 17, 2020. NCPA joined the Alliance for Pharmacy Compounding (APC) and the American Pharmacists Association (APhA) in asking the FDA to extend the comment period due to its substantial impact on access to and the quality of compounded medications in the treatment of animals. NCPA will be submitting comments to FDA on this draft guidance.
NCPA Urges Parity for Medical-at-Home Services
The U.S. Senate Special Committee on Aging held a hearing on home health care in rural America. NCPA submitted a statement for the record outlining long-term care pharmacists' role in expanding access to at-home pharmacy services, also known as "medical at home." We urged the Committee to work with CMS to issue guidance formally recognizing medical at home pharmacy services at the same level as other LTC services. NCPA emphasized that many LTC pharmacies provide specialized in-home care to patients, especially in underserved areas, who might otherwise be in a nursing home due to their need for extra clinical services. For more information on medical at home, please see NCPA's "Overview of Medical at Home Pharmacy Services", available online.
Hawaii PBM Bill Reported Out of Committee
The Hawaii House Consumer Protection Committee and the House Finance Committee reported out HB 1609. The PBM reform bill would require the PBM to act as a fiduciary, prohibit PBMs from requiring more stringent accreditation requirements than the state requires, prohibit copay claw backs, prohibit PBMs from financially incentivizing the use of an affiliate pharmacies (steering), and prohibit spread pricing.
NCPA Supports Enhanced Pharmacist Role
for PrEP Medications in NH
This week, NCPA submitted a letter of support to the New Hampshire House Committee on Health, Human Services and Elderly Affairs on HB 1404. This legislation would increase patient access to HIV pre-exposure prophylaxis (PrEP) medications by authorizing pharmacists to initiate and furnish HIV PrEP medications. NCPA’s letter encouraged the utilization of pharmacists, as the most accessible health care providers, to increase patient access to PrEP medications and to prevent costly downstream medical interventions.
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