CARES Act Signed by President Trump

This week, President Trump signed the CARES Act into law, the $2 trillion federal stimulus package related to COVID-19. The bill includes a number of elements aimed at helping small business that NCPA strongly supported, and for which we've been lobbying aggressively such as making small businesses with 500 or fewer employees eligible for emergency grants and a forgivable loan program. After passage by the Senate late Wednesday night, NCPA sent a letter to House leadership urging quick passage of the bill that will provide vital small business relief. NCPA also joined a letter with other small business advocates in support of small business relief. The House quickly passed the legislation Friday and it was immediately signed into law by President Trump. Congress is expected to take up an additional COVID-19 package in the coming months. Check out NCPA’s in-depth analysis of the small business provisions of the CARES Act here.

Bipartisan Letters Support Relief from DIR Fees
and Expanded Role for Pharmacists

This week, bipartisan letters were sent to Congressional leadership urging them to include provisions in COVID-19 legislation that address pharmacy DIR fees and expand the role of pharmacists during the pandemic. Reps. Raja Krishnamoorthi (D-Ill.), John Rose, (R-Tenn), Vicente Gonzalez (D-Texas), and Buddy Carter (R-Ga.) led the bipartisan letter asking for a temporary pause of pharmacy DIR fees during the COVID-19 public health emergency. The letter was signed by 54 members of the House of Representatives. We thank all those who stepped up and reached out to their Representatives as a whopping 1,966 messages were sent to 365 House offices in less than 24 hours to support this letter.

Additionally, Rep. Buddy Carter (R-Ga.) along with 35 House colleagues sent a bipartisan letter proposing language to provide authority for pharmacist provider status under Medicare Part B to allow pharmacists prescriptive authority and health testing capabilities to address the COVID-19 virus as well as flu, strep, and other minor ailments for the duration of this public health emergency. NCPA will continue working with Congressional champions to include these provisions in any subsequent legislation to address the COVID-19 pandemic.

NCPA Asks CMS for Relief
for Community Pharmacies

This week, NCPA submitted a letter to CMS Administrator Seema Verma applauding CMS’ waiver of signature requirements, but also asking for relief. Specifically, we asked CMS to (1) require Part D sponsors and PBMs to temporarily suspend all pharmacy audits during the public health emergency; and (2) provide clear guidance stating that Part D sponsors and PBMs are not able to audit pharmacies in the future for any alterations or waivers of Part D sponsor and PBM requirements, including patient signatures as proof of delivery for any medications, made during this emergency period. Lastly, we expressed our members’ concerns about the impact that Part D pharmacy DIR fees are having during this pandemic. NCPA will continue to advocate for community pharmacies and offer our willingness to work with CMS during this pandemic.

PCMA Files Its Supreme Court Brief,
Pharmacy Community Responds

This week, PCMA filed its brief as respondent in the Rutledge v. PCMA case arguing that states have no authority to regulate PBMs. NCPA, the American Pharmacists Association (APhA) and Arkansas Pharmacists Association (APA) promptly responded with a joint release refuting this assertion. 
For information and updates on the case, visit NCPA's Battleground: SCOTUS page.

Opportunity for Enhanced Dispensing Fees
for Home Delivery in Medicaid
Due to NCPA Advocacy

In response to President Trump’s national emergency declaration, NCPA advocated that CMS take steps to remove red tape to allow states more flexibility in amending their Medicaid programs to provide appropriate benefits to respond to the COVID-19 outbreak. CMS has provided a template for states to request an1135 waiver to amend their state Medicaid plans to battle the disease. One of the benefits highlighted in the template is an adjustment to the professional dispensing fee for home delivery.

To help simplify the process for Medicaid agencies, NCPA and CPESN created a document, which can be shared with respective state agencies, providing recommendations for covered services, delivery fees, and coding.

NCPA Provides State Emergency
Model Language to Address Audits

PBMs conducting audits during this time of crisis is unacceptable. In response, NCPA drafted model audit language to be used for an Executive Order or other regulatory order. This model language addresses audits conducted during the period of declared emergency and future audits that may have a look back period during the declared emergency.

NCPA Provides State Emergency Model Language
to Address Pharmacy Access/Reimbursements

NCPA is aware of issues related to outdated MACs, drug substitutions to respond to shortages, and patients not being able to access the pharmacy of their choice. In response, NCPA drafted model reimbursement/patient access language to be used for an Executive Order or other regulatory order to address these issues.

NCPA Shares Concerns Over Audits
with State Attorneys General

NCPA was asked to submit issues of concern for a conference call where over half the state attorneys general would be participating. NCPA highlighted the fact that PBM audits were still being conducted during this time of emergency and shared our model audit language.

Ohio and Oklahoma Suspend Pharmacy Audits
During COVID-19 Emergency

The Ohio Superintendent of Insurance has issued an order directing Administrators (e.g., PBMs and health insurance companies) to suspend pharmacy audits for the duration of the state of emergency declared by Gov. Mike DeWine (R) in response to the COVID-19 outbreak.

The state of Oklahoma took similar action as Oklahoma Insurance Commissioner issued an order directing PBMs to cease pharmacy audits for the duration of the Declaration of Emergency issued by Gov. Kevin Stitt in response to the COVID-19 outbreak.

States Act to Prevent Hoarding of Chloroquine
and Hydroxychloroquine

In response to reports of providers prophylactically prescribing prescriptions of chloroquine (CQ) and hydroxychloroquine (HCQ) for themselves, their families, and colleagues, a handful of states have acted prohibiting such practice. These states include ID, NV, NY, OH, OK, TX, WV. Pharmacists may only fill prescriptions for CQ and HCQ for legitimate medical purposes. Some conditions include:

• Prescription bears written diagnosis from prescriber consistent with evidence for use
• Prescription is limited to a fourteen-day supply, unless patient was previously established on the medication (i.e. patient use for rheumatoid arthritis)
• No refills permitted unless a new prescription is furnished

NCPA Encourages FDA to Utilize Compounding Pharmacists
During COVID Crisis

NCPA joined the Alliance for Pharmacy Compounding (APC), American Pharmacists Association (APhA), and the National Alliance of State Pharmacy Associations (NASPA) in a letter to FDA urging the agency to help pharmacists provide urgently needed compounded products due to certain over-the-counter (OTC) and prescription products that are at risk for shortage during the current COVID-19 crisis. NCPA will continue to engage with the FDA to ensure the role of compounding pharmacists is maximized during this public health emergency.

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.

CISA Recognizes Pharmacies as Critical Infrastructure

Cybersecurity and Infrastructure Security Agency (CISA) – part of the Department of Homeland Security – has recognized pharmacies and pharmacy staff as critical infrastructure in their Memorandum on Identification of Essential Critical Infrastructure Workers During COVID-19 Response. In a response letter, NCPA expressed appreciation for this acknowledgement of the vital role community pharmacies and their staff have in the ongoing emergency response to COVID-19, and emphasized that community pharmacies need equal access to personal protective equipment in order to continue contributing to the response effort.

USP Provides Regular Updates for Compounding
Alcohol-Based Hand Sanitizer

USP has a regularly updated resource for pharmacists to address shortages of alcohol-based hand sanitizers associated with the COVID-19 pandemic. The most recent update includes recommendations in response to stakeholder questions about substitutions in light of shortages of ingredients.

CMS Section 1135 Waiver FAQs
for Part B Provider/Supplier Enrollment

As part of ongoing CMS actions in response to the coronavirus emergency, CMS is using its authority under Section 1135 of the Social Security Act to offer flexibilities with Medicare provider enrollment. CMS released an FAQ document that provides Part B providers and suppliers details on expedited applications, waived screening requirements, postponement of formal accreditation and reaccreditation, and more.

NCPA Hosts National Pharmacy Teleconference on COVID-19

NCPA on Sunday night hosted a national pharmacy teleconference on COVID-19. NCPA staff briefed members on legislative, regulatory, and industry developments triggered by the crisis. Click this link to hear the full teleconference.

North Carolina Association of Pharmacists
Reaches Out to White House

The North Carolina Association of Pharmacists (NCAP) sent a letter earlier this week to Mark Meadows, the new White House chief of staff. Meadows is a former Member of Congress for North Carolina’s 11th Congressional District. The letter urged the Trump Administration to suspend pharmacy DIR fees, audits and Part D contract negotiations during this declared emergency. The letter also urges the Administration to allow pharmacists to provide point of care testing, as well as other services, to battle the COVID-19 pandemic. NCPA appreciates North Carolina’s efforts in reaching out to the White House.

West Virginia Provider Status Bill Signed into Law

Governor Jim Justice of West Virginia (R) signed WV SB 787 into law. This bill authorizes paid benefits for pharmacist provided health care services. NCPA joined with the American Pharmacists Association, American Society of Health System Pharmacists, National Association of Chain Drug Stores, and National Alliance of State Pharmacy Associations on a letter of support for 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