NCPA Offers Coronavirus Information Posters

NCPA has created coronavirus posters available to community pharmacies if they wish to post them to provide basic information. They are modified from posters created by the Irish Pharmacy Union. One poster provides tips about ways to protect yourself, such as frequent hand-washing and covering your nose and mouth if you cough or sneeze. The other describes symptoms and steps to take if you experience symptoms. The posters are one more resource NCPA is making available to NCPA members in the wake of the pandemic.

Keep Up With COVID-19

Community pharmacists are on the front line of every public health challenge. To keep you in the know, NCPA has created a page with links to the latest news on this developing story. Access the coronavirus page here.

CMS Directs Plans to Relax Home and Mail
Delivery Requirements for Retail Pharmacies

\ This week, President Trump met with insurance companies to create a joint effort amongst Medicare and Medicaid to help prevent the spread of COVID-19. Shortly thereafter, Centers for Medicare & Medicaid Services Administrator Seema Verma mentioned release of CMS guidance outlining the flexibilities Medicare Advantage and Part D plans have to waive certain requirements to help combat the disease. These include:

• Waiving cost-sharing for COVID-19 tests
• Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
• Removing prior authorizations requirements
• Waiving prescription refill limits
• Relaxing restrictions on home or mail delivery of prescription drugs for retail pharmacies
• Expanding access to certain telehealth services

To ensure pharmacy access during a disaster or state of emergency resulting from COVID-19, CMS includes flexibilities for retail pharmacies regarding mail and home delivery of prescription drugs: “In situations when a disaster or emergency makes it difficult for enrollees to get to a retail pharmacy, or enrollees are actually prohibited from going to a retail pharmacy (e.g., in a quarantine situation), Part D sponsors are permitted to voluntarily relax any plan-imposed policies that may discourage certain methods of delivery, such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances.” In addition, CMS directs Part D sponsors to ensure enrollees have adequate access to Part D drugs dispensed at out-of-network pharmacies; enrollees would be responsible for any cost sharing under their plan.

NCPA supports urging CMS to require, rather than allow, Part D sponsors to relax any restrictions on retail pharmacies that would discourage them from offering mail or home delivery services, and suspend any conflicting contract language that may interfere with these relaxed requirements on retail pharmacies. NCPA encourages community pharmacies to work with their plan sponsors to explore participating in mail or home delivery services in light of this CMS guidance.

Coronavirus State Executive Orders
Regarding Pharmacy Dispensing

Almost 30 states have issued emergency executive orders suspending certain regulations on a pharmacies’ ability to provide prescription and refills for their patients. States like Kentucky, Florida and North Carolina have all relaxed some of their dispensing requirements.

CMS and AHCA Encourage Nursing Facilities
to Screen and Limit Visitors

The federal government and the American Health Care Association, the nation’s largest nursing home association, are calling on providers to limit — and in some cases restrict — visitor access in order to prevent the spread of coronavirus in facilities across the country.

Facilities should "actively screen and restrict" visitors who have either shown symptoms of a respiratory infection; come into contact with someone diagnosed with COVID-19 or under under investigation for COVID-19; traveled internationally to a country within the last 14 days that has sustained community transmission; or reside in a community where the disease is spreading. If visitors pass the screening and are allowed to enter, the guidance suggests that facilities give them access to their resident’s room only. Please view CMS guidance for nursing homes and CMS guidance for hospice providers for further details.

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

This week, Reps. Doug Collins (R-Ga.), Ranking Member of the House Judiciary Committee, Peter Welch (D-Vt.), and 41 other House members sent a letter to the Department of Justice (DOJ) Antitrust Division and the Federal Trade Commission (FTC) Bureau of Competition voicing concerns regarding vertical mergers, specifically in the health care space. As previously reported, the letter urges the agencies to adopt stricter guidelines for evaluating vertical mergers and that they 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. In their press release, Reps. Collins and Welch both stressed the harm these mergers have cause to patients and small business, independent community pharmacies. NCPA CEO Doug Hoey was also quoted in the press release.

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.

There is still much to be done to support community pharmacy in this landmark case prior to the April 27 oral arguments. This takes substantial resources. If you have not done so, please consider an investment in NCPA's Legislative/Legal Defense Fund, or participate in Pharmacy Providers of Okalhoma’s (PPOk’s) PBM "Fiduciary Responsibility” challenge. This is a fun way to raise awareness of PBM abuses and proceeds from the challenge help defray the legal costs in supporting the state of Arkansas in Rutledge v. PCMA. 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. You can view videos of NCPA staff taking the challenge here.

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

Major Medicaid Reform Bill Passes
Both the Kentucky House and Senate

This week, Kentucky SB 50, sponsored by Sen. Max Wise (R), unanimously passed the House. SB 50 has already passed the Senate. Although SB 50 is no longer the original "carve-out" bill, it does provide some major Medicaid managed care reforms. In its current form, SB 50 provides that a single PBM will administer the pharmacy benefit in Kentucky's Medicaid managed care program. The state will choose the PBM, and the single PBM will administer the benefit for all participating MCOs. Additionally, the state Medicaid agency, not the PBM, will determine the minimum reimbursement a pharmacy can be paid for ingredient cost and professional dispensing fee. Finally, the state will establish a single preferred drug list for all MCOs. This legislation is a first step in providing transparency and much needed oversight in Kentucky's Medicaid managed care program.

Register Now for the 2020 NCPA
Congressional Pharmacy Fly-in

Registration for NCPA’s 2020 Congressional Pharmacy Fly-in isopen. 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. Note: At this time, NCPA is still planning to hold the Fly-in as scheduled. However, participants will be notified if anything changes. Visit our Congressional Pharmacy Fly-in webpage for more information.

NCPA Joins Pharmacy Groups
in Opposition to Drug Importation

NCPA signed on to joint comments with the Academy of Managed Care Pharmacy, American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, College of Psychiatric and Neurologic Pharmacists, and the National Alliance of State Pharmacy Associations opposing the FDA's proposed rule allowing wholesale importation of prescription drugs from Canada. The joint comment letter opposes importation based on patient risk and the likelihood that importation will not produce meaningful cost savings. NCPA also submitted separate comments opposing the rule on the same grounds, suggesting alternative policy options for reducing drug prices, such as increased PBM regulation. NCPA will continue to engage with FDA and other stakeholders to identify solutions to reduce drug prices without risking public health and safety.

CMS & ONC Finalize
Interoperability Provisions

This week, the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) released two final rules addressing interoperability and patient access to health information. The ONC final rule supports patients’ access to their electronic health information (EHI) in a form convenient for patients, such as making a patient’s EHI more electronically accessible through the adoption of standards and certification criteria and the implementation of information blocking policies that support patient electronic access to their health information at no cost. Health care providers (including pharmacists), health IT developers of certified health IT, health information exchanges, and health information networks do not have to comply with the information blocking provisions until September 9th, 2020. ONC offers information blocking exceptions, which consist of two categories. ONC also emphasizes that, to the extent that a pharmacy conducts electronic prescribing with prescribers e-prescribing Part D covered drugs for Part D eligible individuals, those pharmacies are required to use the NCPDP SCRIPT version 2017071 standard.

The CMS final rule requires CMS-regulated payers to implement and maintain a secure, standards-based application programming interface (API) that allows patients to easily access their claims and encounter information, including cost, as well as a defined sub-set of their clinical information through third-party applications of their choice. The final rule also requires hospitals to send electronic admissions as well as discharge and transfer notifications to patients’ primary care team as identified by the patient, thus including pharmacists. This is also effective September 9th, 2020.

New CMS Senior Savings Model
Would Reduce Patient Insulin Costs

This week, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary Model – the Part D Senior Savings Model – that enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin. Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, marketed by Model-participating pharmaceutical manufacturers, at a maximum $35 copay for a 30-days’ supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit.

USP Grants Appeals on <795> and <797>

This week, the USP Appeals Panel granted appeals on General Chapters <795> and <797> submitted by the Alliance for Pharmacy Compounding (APC), Innovation Compounding, and Wedgewood Pharmacy. As such, the Appeals Panel remanded these chapters to the Compounding Expert Committee with the recommendation for further engagement with regards to the issues raised in the appeals, including the overly restrictive beyond-use-dates (BUDs) in <797>. The Expert Committee is responsible for determining future modifications, if any. NCPA attended the respective hearing in January to support these substantive concerns, as outlined in a letter we submitted to USP along with the American Pharmacists Association (APhA). Due to these appeals, the currently official versions of <795> (last revised in 2014) and <797> (last revised in 2008) remain official. The Appeals Panel has also recommended that USP evaluate its appeals process to provide potential appellants greater opportunity for substantive engagement.

NCPA at OMCPA in West Virginia

NCPA’s Matt Magner presented a CE session during an event hosted by the Ohio Marshall County Pharmacists Association in Wheeling, West Virginia. The presentation covered current and future trends in community pharmacy, included federal and state legislative updates that impact community pharmacies. Pharmacists from West Virginia, Ohio, and Pennsylvania attended the event.

Virginia Prohibits Spread Pricing

Virginia Governor Ralph Northam signed HB 1290, which prohibits the use of spread pricing in the commonwealth. The legislation, sponsored by legislator and pharmacist Keith Hodges (R-VA) also requires PBMs to become licensed with the State Corporation Commission, prohibits adjudication fees, prohibits PBMs from reimbursing their own pharmacies at higher rates than other pharmacies, and contains other protections for patients, pharmacies, and plan sponsors.

Indiana General Assembly
Passes PBM Regulations

The Indiana General Assembly passed SB 241, a PBM regulation bill. Under the bill, PBMs would be prohibited from retroactively adjusting claim amount, establishing arbitrary pharmacy accreditation requirements, and reimbursing PBM-owned pharmacies at more favorable rates. The bill also contains other patient and pharmacy protections, and is awaiting Gov. Eric Holcomb’s signature.

West Virginia Legislature Passes Pharmacist Provider Status Legislation

The West Virginia Legislature has passed WV SB 787, a bill that authorizes paid benefits for pharmacist provided health care services. Pending the Governor Justice’s signature, paid benefits will be provided to pharmacists for care rendered within the pharmacist’s scope of practice if such benefits would ordinarily be paid if the service was performed by another health care provider. NCPA signed onto a joint letter of support with the American Pharmacists Association, American Society of Health System Pharmacists, National Association of Chain Drug Stores, and the National Alliance of State Pharmacy Associations championing this legislation which recognizes pharmacists as part of the health care team.

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