NCPA and Pharmacy Allies File Amicus Brief
in Rutledge v. PCMA

This week, NCPA, the Arkansas Pharmacists Association, the American Pharmacists Association, the National Alliance of State Pharmacy Associations, and every state pharmacy association, filed an amici curiae brief with the Supreme Court in support of the state of Arkansas in the Rutledge v. PCMAcase, which goes before the court on April 27. At issue is the right of a state to regulate a PBM within its borders. While the legal brief may be complete, the legal battle goes on. There is still much to be done to support community pharmacy in this landmark case. This takes substantial resources. If you have not done so, please consider an investment in NCPA's Legislative/Legal Defense Fund. 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.

For information and updates on the case, visit NCPA's Battleground: SCOTUS page.

Rally at the Supreme Court as Justices
Hear Rutledge v. PCMA

On April 27, pharmacists from across the country will rally at the steps of the Supreme Court as justices hear oral arguments in the landmark case Rutledge v. PCMA. If you plan to join us, please RSVP through this link so we have an idea of how many pharmacists we can expect. View these FAQs for more information on the rally. We hope you can join us to add to the powerful image of pharmacists in their lab coats uniting their voice on the need for PBM oversight and regulation.

PPOk Launches the “Fiduciary Challenge”

Earlier this week, Pharmacy Providers of Oklahoma launched the “Fiduciary Challenge” on their website in support of NCPA’s Legislative and Legal Defense Fund and promoted it across all their social media channels. Similar to the “Ice Bucket Challenge”, PPOk’s CEO, John Crumly, recorded himself challenging community pharmacy leaders and his own employees and customers to place 9 large marshmallows (one for each Supreme Court Justice) in their mouth and say “Fiduciary Responsibility”, which PBMs cannot say even without a mouthful of marshmallows. If the challenged person can’t say “Fiduciary Responsibility” then they have to donate at least $20 to NCPA’s LDF. Those who are challenged get to nominate at least three other people to take the challenge. Watch this space for an update next week on NCPA leaders accepting the challenge.

Community Pharmacy – an Eager Partner
in Coronavirus Containment

As the most accessible health care providers in many communities, neighborhood pharmacists are well-positioned to assist with efforts to curb and contain the coronavirus outbreak disease, the National Community Pharmacists Association said in a letter to the U.S. Department of Health and Human Services’ top emergency preparedness official. Dr. Robert Kadlec, the Assistant Secretary of Preparedness and Response, was tasked this week with coordinating the government’s response to the ongoing outbreak. In the letter, NCPA CEO B. Douglas Hoey said: “I write today to offer our willingness to work collaboratively with HHS to curb the spread of the 2019 novel coronavirus disease (COVID‐19) and play an integral role in any containment campaign. Independent community pharmacy is ready and willing to help and is well‐positioned to be part of the solution.” NCPA has also developed a resource page that will include timely information on the outbreak.

NCPA Officer Hosts U.S. Deputy Surgeon General
for a Pharmacy Visit

On Tuesday, NCPA second vice president Michael Kim hosted the U.S. Deputy Surgeon General, Rear Admiral Erica Schwartz, at Grubb’s Southeast Pharmacy and Mini Mart. Also present were HHS staff, Health Mart President Nimesh Jhaveri and Care Pharmacies CEO Mike Wysong, along with NCPA staff. Topics of conversation included how community pharmacy can assist with facilitating patient access to HIV PrEP and PEP medications as well as uncertainty caused by pharmacy DIR fees. NCPA staff also reiterated how community pharmacy can play a valuable role in coronavirus containment efforts and shared a copy of NCPA CEO Douglas Hoey’s related letter to Dr. Kadlec.

Reps. Collins and Welch Lead Congressional Support
for Tougher Merger Guidelines

Reps. Doug Collins (R-Ga.) and Peter Welch (D-Vt.) are circulating a sign-on letter among their House colleagues addressed to the Department of Justice and Federal Trade Commission. The letter urges the agencies to adopt stricter guidelines for evaluating vertical mergers. As the letter notes, agencies must strengthen their approach to vertical merger enforcement, in order to better promote market competition and protect consumers. This is particularly critical in the pharmacy sector where the 3 largest PBMs control more than three quarters of all prescriptions filled in America- equaling over 3.3 billion prescriptions. NCPA has a letter available on the Legislative Action Center that can be sent to Representatives urging them to sign-on to this letter. The deadline for signing on has been extended to Wednesday, March 11, so please contact your Representative as soon as possible.

NCPA Video Highlights Advocacy Wins

NCPA most recent advocacy wins video includes recent highlights of members of Congress speaking of PBM abuses and the importance of community pharmacy and other accomplishments since the 2019 NCPA Congressional Pharmacy Fly-in. While much work still remains, the video is evidence that policymakers are understanding the role PBMs play in increasing prescription drug costs for consumers and how they use their market power to the detriment of community pharmacies and that legislative solutions are necessary to address these practices.

Register Now for the 2020
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. You will also have the opportunity to participate in a press event at the Supreme Court prior to the oral arguments in Rutledge v. PCMA and larger rally the following week on April 27.

Survey Says: Cost of Dispensing on the Rise

According to a new Cost of Dispensing Study, the average overall cost of dispensing in 2018 was $12.40 per prescription (up from $10.55 in 2014), and $12.45 for Medicaid prescriptions (up from $10.30 for Medicaid). The study, commissioned by NCPA, the National Association of Chain Drug Stores, and the National Association of Specialty Pharmacy, was released Tuesday. The goal of the study is to give state Medicaid programs, state legislators and governors information they can use to align their programs with the access needs of the most vulnerable patients, and with fairness for pharmacy patient care. An FAQ on the survey can be found here.

NCPA Supports Greater PBM Transparency
in the Commercial Market

This week, NCPA submitted comments to HHS/CMS on its 2021 Notice of Benefit and Payment Parameters Proposed Rule. NCPA supported CMS’ proposal to amend medical loss ratio (MLR) reporting requirements for non-federal governmental plans. CMS contemplates requiring plans to deduct, from incurred claims, prescription drug rebates and other price concessions (including DIR), not only when received by the plan, but also when received by a PBM. NCPA also expressed concern with CMS’ proposal to allow plans to except manufacturers’ payments from counting toward a patient’s annual limitation on cost-sharing. NCPA will monitor CMS’ publication of the final rule.

NCPA Comments on CMS’
Proposed Measures in Part D

NCPA submitted comments to CMS on its 2021 Advance Notice for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. NCPA supported CMS’ proposals to consider implementing PQA measures relating to opioids policies and medication adherence. NCPA also urged CMS to encourage its measure to control high blood pressure to be endorsed for pharmacies, citing that 57% of all independent community pharmacies offer blood pressure monitoring. Further, NCPA encouraged CMS to work with PQA before implementing generic utilization measures, as they could lead to unintended consequences, such as interfering with the provider-patient relationship.

MedPAC Holds Meeting on Medicare
Part D and MA Quality

This week, the Medicare Payment Advisory Committee (MedPAC) held its public meeting on redesigning the Medicare Advantage (MA) quality bonus program and restructuring Part D, focusing on low-income subsidy (LIS) beneficiaries. The topic of discussion surrounding MA quality was that the current program has many flaws due to excessive measures, poor implementation, and high costs. A redesigned MA-Value Incentive Program would be patient-oriented, score a small set of measures, and encourage care coordination across providers. The session on restructuring Part D focused on considerations for plans serving LIS beneficiaries, asserting that risk adjustment would be an essential element of a redesigned Part D benefit. The Chairman’s draft recommendations would make plans responsible for 75% of spending between the deductible and out-of-pocket (OOP) threshold. The Commissioners pointed out that DIR and rebates need to be explored when finalizing any restructuring of the Part D program. NCPA continues to monitor MedPAC’s meetings and seeks opportunities to address the committee on issues pertaining to community pharmacy.

FDA Reports on CBD

This week, the FDA released a new report on cannabidiol (CBD) stating it is still evaluating issuance of a risk-based enforcement policy that would provide greater transparency and clarity regarding FDA enforcement decisions. The report responds to a directive from U.S. Senate Majority Leader Mitch McConnell (R-Ky.), who gave the agency a timeline to create an enforcement discretion policy for CBD. Although the report falls short of providing the regulatory clarity CBD makers were seeking, it does include updates on the agency’s regulatory work, including:

• Establishing a process by which proprietary studies regarding specific CBD products can be submitted to the FDA without exposing confidential information
• Holding a call with state public health officials about CBD safety surveillance later this year
• Conducting a study using a rat model to better understand the impact of CBD exposure during pregnancy
• Partnering with the University of Mississippi to evaluate CBD and THC levels in cosmetic products

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