COVID-19 Alert: NCPA to Host
National Pharmacy Teleconference on Sunday

NCPA will host a national community pharmacy tele-conference on Sunday, March 22, 2020, at 8 pm ET to brief members on the fast-moving developments surrounding the COVID-19 pandemic as they affect independent pharmacies and their patients. We will cover the impact on community pharmacy of:

• The latest guidance and information from the CDC, HHS and the administration
• Policy developments relating to federal regulation and legislation
• Industry developments, including supply chain issues

Please click this link to register for the event. Participants can choose to dial in or use the audio streaming service. This will be a moderated call and it will be recorded. There will be limited opportunity for questions. If you are chosen to ask a question, please keep it brief so we can accommodate as many participants as possible. Note that on the registration form, there is space for you to submit a question in advance.

NCPA Coronavirus Resources

There is new news and information surrounding COVID-19 disseminated daily and new developments occurring rapidly. Content on NCPA’s coronavirus page website is being updated on a regular basis and contains resources for pharmacists. Additionally CMS has also developed a coronavirus toolkit.

NCPA Provides Recommendations on Utilization
of Pharmacists to Combat COVID-19

This week, NCPA sent letters to Vice President Mike Pence and members of the administration's Coronavirus Task Force, as well as Congressional leadership, on how community pharmacy is ready and willing to assist with fighting the epidemic, as well as allowances needed in order for small business neighborhood pharmacies to continue to provide assistance to patients in this time of emergency. This follows a March 2 letter sent by NCPA to the U.S. Department of Health and Human Services' top emergency preparedness official offering community pharmacy's assistance.

CMS Issues Additional Guidance to Part D Sponsors
Easing Audit Requirements for Signature Logs

Today, CMS issued a memo stating HHS does not require and will not audit for patient signatures as proof of delivery for any medications, including for controlled substances. CMS encourages Part D sponsors to work with their downstream entities to identify ways to ensure medications are delivered to patients without requiring face-to-face contact, which could result in transmission of the coronavirus.

Tell Congress to Ensure Patients Maintain Access
to Community Pharmacies

Congress is working on its third legislative relief package pertaining to the current COVID-19 health crisis.

This third legislative package is expected to move swiftly. NCPA has created a grassroots message pharmacists can send to their respective legislators urging inclusion of provisions to eliminate pharmacy DIR fees and ensure adequate reimbursements in Medicaid Managed Care. If you have not yet done so, please take a moment to contact your legislators and urge them to support including these measures in the legislation.

Families First Coronavirus Response Act Becomes Law

This week, President Trump signed into law H.R. 6021, the Families First Coronavirus Response Act (FFCRA), which takes effect April 2, 2020. FFCRA requires small businesses with fewer than 500 employees to provide employees with 2 weeks of paid sick time if they demonstrate “a qualifying need related to a public health emergency,” and an additional 10 weeks of paid family leave to care for a child whose school or childcare provider is unavailable for reasons related to coronavirus. FFCRA authorizes the Secretary of Labor to exempt health care providers from the expanded sick and family leave provisions, as well as small businesses with fewer than 50 employees when providing FFCRA required leave would jeopardize the viability of the business. NCPA is aggressively advocating to ensure pharmacies and pharmacists are included within the health care provider exemption under the Emergency Family and Medical Leave Expansion Act and the Emergency Paid Sick Leave Act and sent a letter to Labor Secretary Eugene Scalia, urging the DOL to work with Congress to explicitly include pharmacists under the exemption.

Additionally, this week NCPA joined with the National Grocers Association in demanding flexibility in managing the workforce to ensure access to food and medicine while simultaneously protecting workers and patients from the virus. We also teamed with 111 organizations on another effort to provide access to paid leave while giving relief to businesses throughout the country, and with these organizations, further support businesses in reducing costs and increasing cash flow.

For more details, on the FFCRA, see NCPA's member summary.

NCPA Joins Pharmacy Groups to Support Enabling
Pharmacists to Aid in Response to COVID-19

This week, NCPA endorsed a joint set of policy recommendations critical to a full response to the COVID-19 pandemic that were developed by organizations representing the interests of all pharmacists in the United States. The full list of recommendations can be found here and NCPA’s news release is available here.

Resources for Small Businesses in Response
to the Novel Coronavirus Pandemic

In response to the evolving coronavirus crisis, Congress and the Administration are issuing guidances on issues of importance to small business community pharmacies on an expedited basis. To ensure that you are acting on the most up-to-date and accurate information, NCPA encourages you to visit the Small Business Administration (SBA) Office of Advocacy webpage, which has a list of resources for small businesses and up-to-date links to specific guidelines issued by the appropriate federal agency.

IRS Defers Tax Filings and Payments

This week, the Internal Revenue Service (IRS) released Notice 2020-17, which provides “Relief for Taxpayers Affected by the Ongoing Coronavirus Disease 2019 Pandemic.” The notice provides relief for any taxpayer with a Federal income tax payment due on April 15, 2020. Such payments will not be due until July 15, 2020, for amounts up to $10,000,000 for C corporations and up to $1,000,000 for individual filers and pass-through businesses. Additionally, Treasury Secretary Stephen Mnuchin extended the filing deadline of any tax return to July 15, 2020. NCPA recommends community and LTC pharmacies to consult their respective tax advisers to ensure appropriate compliance with this notice.

2020 Congressional Pharmacy Fly-in
and Supreme Court Rally Cancelled

Due to the situation with COVID-19, NCPA announced this week that the Congressional Pharmacy Fly-in scheduled for April 21-22 has been cancelled. NCPA is researching alternative venues and dates for possibly rescheduling and will share any new information when and if it becomes available.

This situation has also resulted in the cancellation of the Supreme Court rally scheduled for April 27.

While the rally is cancelled, the Supreme Court is still scheduled to hear oral arguments in Rutledge v. PCMA on April 27. However, all hearings scheduled for March have been postponed, and that could affect the rest of the court calendar. We will monitor the situation and update the NCPA SCOTUS resource page regularly.

Kentucky Legislature Passes
Medicaid Managed Care Reform

The Kentucky Legislature passed SB 50, which reforms the prescription drug benefit in the commonwealth’s Medicaid managed care (MMC) program. Under the bill, the state would contract with a single PBM to administer MMC benefits, and the Medicaid department would be responsible for establishing reimbursement methodologies and dispensing fees. The bill contains additional protections for pharmacies and Medicaid beneficiaries. The bill has been delivered to Gov. Andy Beshear (D) and awaits his signature.

MedPAC Releases March 2020 Report
on Medicare Payment Policy

The Medicare Payment Advisory Commission (MedPac) released its March 2020 report this past weekend, including a chapter on prescription drug coverage. Between 2007 and 2018, Part D program spending increased from $46.2 billion to $83.4 billion—an average annual growth rate of 5.5 percent. The report indicates that it is not clear that current quality metrics help beneficiaries to make informed choices among their plan options. The report cited NCPA in stating the way in which plan sponsors and PBMs calculate pharmacy DIR fees is not transparent and that plan sponsors ignore or understate DIR fees when preparing Part D bids, leading to enrollee premiums that are too high. Additionally, the report stated that based upon plan sponsors’ assumptions about rebates from their 2019 bids, the Medicare Trustees estimated that DIR – consisting predominantly of manufacturers’ rebates, but also pharmacy DIR – amounted to 27.3 percent of total drug costs (Boards of Trustees 2019).

NCPA Asks FDA for Compounding
Hand Sanitizer Clarification

This week, NCPA joined the American Pharmacists Association, Alliance for Compounding Pharmacy, and National Alliance of State Pharmacy Associations in a letter to the FDA requesting clarification on FDA’s recent Policy for Temporary Compounding of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency. The letter asserted that challenges yet remain with the guidance, which if not addressed by FDA in a timely manner, will limit the effectiveness of FDA’s guidance and pharmacy compounders’ ability to be helpful in COVID-19 prevention efforts. NCPA will continue to monitor and engage with the FDA on compounders’ ability to participate in curbing the spread of COVID-19.

In response to receiving request for additional guidance from our pharmacy groups and others, FDA issued a second guidance, Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (COVID-19), outlining direction in preparing and distributing hand sanitizer products. FDA further stated that it will not action against firms that prepare alcohol-based hand sanitizers for consumer use and for use as health care personnel hand rubs for the duration of the public health emergency.

DEA Responds to COVID-19

Upon the declaration of a public health emergency in response to COVID-19, the Drug Enforcement Administration (DEA) worked in consultation with HHS to allow DEA-registered practitioners to begin issuing prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation. DEA-registered practitioners may continue this telemedicine practice for as long as the designation is in effect, if certain conditions are met. Provided the practitioner satisfies these requirements, the practitioner issue a prescription electronically or by calling in a prescription to the pharmacy. Click here for updates, resources, and additional information on DEA’s COVID-19 response.

Schaeffer Institute Reports on Sharing Rebates
at Point-of-Sale

The USC Schaeffer Institute issued a report on sharing rebates at the point-of-sale, and the impact that would have on beneficiary cost-sharing in Medicare Part D. The report states that rebates have grown considerably over the last decade and emphasizes that patient cost-sharing is based on the list (pre-rebate) price of drugs, not the net price reflecting negotiated discounts. The report concludes that if cost-sharing were based on net price, it would reduce out-of-pocket spending for nearly 50 percent of Part D beneficiaries.

NCPA Submits Letter of Support for Amendments
to New York’s Immunizer Laws

NCPA submitted a letter of support to Gov. Andrew Cuomo (D) and New York lawmakers urging support of the provisions in the Executive Budget that would amend New York’s immunizer laws. Under the amendments, certified pharmacists in the New York would be authorized to provide all CDC-recommended vaccines to adults.

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.