Pharmacy Community Urges Cooperation from PBMs

This week, NCPA joined the Food Marketing Institute, National Association of Chain Drug Stores and National Grocers Association in asking for cooperation from Pharmaceutical Care Management Association (PCMA) member companies during the COVID-19 national emergency. In a letter to PCMA, the groups asked PCMA to "urge your member companies to immediately remove barriers to care so we can be fully prepared to meet the demand of those affected by COVID-19." Among the requests: waive all signature requirements, suspend all forms of pharmacy audits, eliminate restrictions on home delivery and mailing of prescriptions.

NCPA CEO Doug Hoey Interviewed on Fox Business

NCPA CEO Douglas Hoey was a guest on Tuesday night's "After the Bell," with Melissa Francis on Fox Business. He discussed the role community pharmacies play as a safety net during a public health crisis, as well as in normal times.

SCOTUS Update: Oral Arguments Postponed
and PBM Allies File Briefs in Rutledge v. PCMA

The Supreme Court just announced that it is postponing April oral arguments, including Rutledge v. PCMA. The Court is still trying to determine when and how it might resume arguments but has not ruled out hearing March and April arguments before the end of the term which is the end of June. Also,this week, supporters of PCMA, including U.S. Chamber of Commerce, the Society for Human Resource Management (SHRM), America’s Health Insurance Plans (AHIP), J.B. Hunt Transport Services, Inc. (an Arkansas-based overland trucking company), Academy of Managed Care Pharmacy, and Employers Health Purchasing Corporation, filed amicus briefs with the Supreme Court in the Rutledge v. PCMA case. The briefs generally rehashed the flawed arguments posed by PCMA in its response to the state of Arkansas’ opening Supreme Court briefing.

CMS Issues Flexibilities for MA
and Part D Plans to Fight COVID-19

This week, CMS released guidance for Medicare Advantage (MA) and Part D plans on temporary regulatory waivers and new rules in response to the COVID-19 pandemic:

• Part D sponsors may relax policies that discourage pharmacies from offering mail or home deliveries;
• Part D sponsors may relax their “refill-too-soon” edits and allow an affected enrollee to obtain the maximum extended day supply available;
• CMS is pausing much of their standard medical review activities, including prior authorization and reviews that require provider documentation; and
• CMS removed the requirement for Medicare health plans to submit Healthcare Effectiveness Data and Information Set (HEDIS) 2020 data covering the 2019 measurement year for the Medicare program; CMS also alters its Star Ratings data collection requirements.

See NCPA’s summary here.

State Medicaid Programs Can Waive Receipt Confirmation

CMS updated their FAQs this week, and addressed signature-less delivery. Federal law does not preclude states from completely waiving the receipt confirmation requirement (i.e., no signature, email, phone, text, etc.). Here’s what they have to say: Can states waive signature requirements for beneficiaries to receive their prescription drugs? Must beneficiaries continue to receive counseling on their medications?

There are currently no federal Medicaid rules that require beneficiaries to provide their signature in order to receive prescription drugs. Requirements for signatures are usually found in a state provider manual and are at the discretion of the state Medicaid program. Therefore, CMS encourages states to explore ways to ease state signature requirements in order to allow beneficiaries to access their medications during the public health emergency. Pharmacists should follow state laws regarding counseling patients, which may permit counseling by phone.

CARES Act Expands Use of HSA, FSA Accounts
for OTC Medications

Congress recently passed the CARES Act, which among other things, enhances patient's access to self- care products. Effective immediately, patients can use their health savings account (HSA) or flexible spending account (FSA) for over the counter (OTC) medications and menstrual products. If patients are unable to use their HSA/FSA benefits electronically, remind them to save receipts to submit for reimbursement. You can find signage you can use in your store and on social media here.

NCPA Hosts Webinar on How the CARES Act Can Help
Improve Cash Flow and How to Act on It

The CARES Act, passed last Friday, includes important relief for small businesses including emergency grants, a forgivable loan program, changes to rules for expenses and deductions meant to make it easier for small businesses to keep employees on the payroll and open for business. NCPA advocated for specific small business relief provisions for pharmacy owners. On Thursday, NCPA hosted a webinar featuring accounting experts, Ollin and Scotty Sykes of Sykes and Co., P.A. to breakdown the bill and outline specific actions you can take as a business owner to take advantage of the many resources available. Access the recording, slides, and resources at NCPA’s Coronavirus Resource Center.

Potential Fourth COVID-19 Legislative Package Developing

House Democrats are in the initial stages of crafting a fourth piece of legislation to address the coronavirus pandemic even as leaders signal that it'll be at least a few weeks or more before major steps are taken. Days after the Phase 3 rescue package was signed into law, Speaker Nancy Pelosi (D-Calif.) laid out Democrats' priorities for "phase 4" which include additional direct payments to Americans, expanded food assistance programs and paid sick leave. President Trump on Tuesday encouraged Congress to pass a $2 trillion infrastructure bill as the next piece of legislation to boost the economy amid the coronavirus pandemic. However, Senate Majority Leader Mitch McConnell (R-Ky.) has also indicated the need for a fourth package. NCPA will continue to advocate for relief for community pharmacies as phase 4 legislation continues to develop.

CMS to Allow Pharmacists to Authorize Emergency Refills

CMS notified Part D sponsors on April 3, 2020 that due to the ongoing COVID-19 public health emergency, CMS will exercise its enforcement discretion to allow pharmacists to authorize emergency refills when prescribers are not available to provide refill renewal prescriptions, when consistent with State emergency declarations. Read more here.

Joint Commission of Pharmacy Practitioners
Issue Policy Recommendations Re: COVID-19

NCPA and other members of the Joint Commission of Pharmacy Practitioners (JCPP) released an updated set of policy recommendations critical to empower pharmacists to fully and effectively support the national COVID-19 response. Read the full text of the JCPP statement here.

Mercatus Issues Policy Brief on Relaxing
Pharmacy Regulations Re: COVID-19

George Mason University’s Mercatus Center issued a policy brief, Relax Pharmacy Regulations to Help with COVID-19 Testing and Treatment, addressing the current challenge of how to ramp up diagnostic testing on a mass scale. The brief notably recommends that certain regulatory restrictions on pharmacists, such as those restricting their ability to perform certain tests, should be relaxed so that they can practice to the full extent of their training and abilities during a time when their help is urgently needed.

Kentucky Governor Signs Major
Medicaid Managed Care Reform Bill

Late last week, Kentucky Governor Andy Beshear (D) signed 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. Thank you and congratulations to bill sponsor Senator Maxwell Wise (R) and all pharmacy advocates in Kentucky who worked so hard on this legislation.

NY Legislature Passes Pharmacy Carve-out Legislation

Both chambers of the New York Legislature passed S7506-B, which directs the Department of Health to carve the state’s Medicaid pharmacy benefits out of the managed care program and administer the benefits through the fee-for-service program. The bill has not yet been delivered to Gov. Andrew Cuomo (D) for his signature.

States Issue Emergency Orders
Regarding PBM Practices During COVID-19 Crisis

Pursuant to declarations of states of emergency in response to the COVID-19 outbreak, several states have issued emergency orders governing PBM practices over the past several weeks. The orders include such directives as requiring PBMs to waive signature requirements, suspend pharmacy audits, cease mandatory mail-order requirements, and make it easier for patients to obtain 90-day fills and early refills. Included are links to the orders from Alaska, Arkansas (additional), Connecticut, Delaware, Florida, Kentucky, Louisiana, Massachusetts, Ohio, Oklahoma, Texas, Vermont, and West Virginia.

Washington Enacts PBM Reform Legislation

Washington Governor Jay Inslee (D) recently signed SB 5601 into law, whichrequires PBMs to register with the state, prohibits PBMs from using misleading advertising, prohibits certain adjudication fees and retroactive claim denials and reductions, and limits arbitrary pharmacy accreditation standards as a condition of network participation. The Governor vetoed a section of the bill that would have established a “pharmacy contract work group” which would have been required to detail the current use of performance-based contracts and pharmacy fee structures in the delivery of pharmacy benefits and provide recommendations for designs or use of performance-based contracts in the delivery of pharmacy benefits.

Utah Strengthens PBM Regulations

Utah Governor Gary Herbert (R) signed HB 272, which strengthens the state’s PBM regulations to protect patients, payers, and pharmacies from PBM abuses and conflicts of interest. The newly enacted law prohibits PBMs from reimbursing PBM-owned pharmacies more than non-affiliated pharmacies, limiting a pharmacy’s ability to offer home delivery services, and charging retroactive fees without providing notice to the pharmacy. The law also amends the state’s “anti-mandatory mail-order” laws to strengthen enforcement of those provision. One of the lead sponsors of the legislation was independent pharmacist Sen. Evan Vickers (R).

Indiana Enacts PBM Regulations

Indiana Gov. Eric Holcomb (R) signed SB 241 into law, whichrequires PBMs to become licensed with the state and contains protections for patients and pharmacies. The act is modeled on the model PBM regulations adopted by the National Council of Insurance Legislators (NCOIL) in 2018. Under the new regulations, PBMs may not condition network participation on pharmacy accreditation standards that are more stringent than state or federal requirements, retroactively deny or reduce a claim, or reimburse a PBM-owned pharmacy at higher rates than it reimburses non-affiliated pharmacies. The laws also establishes PBM reporting requirements and requires PBMs to establish a MAC-appeals process.

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