House Passes 2016 National Defense Authorization Act that Includes Small Business Pharmacy Protections for TRICARE Preferred Pharmacy Pilot: The U.S. House on Friday passed the National Defense Authorization Act (NDAA) for fiscal year 2016 (H.R. 1735) by a vote of 269 to 151. NCPA is pleased to report that an amendment offered by Rep. Austin Scott (R-GA) was adopted prior to passage. The amendment provides small business community pharmacy the opportunity to participate in a TRICARE preferred pharmacy pilot program at a rate no less than small business pharmacies currently participate in serving TRICARE patients. The pilot will enable pharmacies willing to participate in the pilot, which will be conducted in one region, the ability to purchase drugs for their TRICARE patients at the greatly reduced Federal Supply Schedule rate. NCPA fought for its members to be included in the pilot, and thanks Rep. Scott for his support of independent pharmacy. The House version of the NDAA still must be reconciled with a Senate bill and adopted by both chambers before being sent to the President.

21st Century Cures Draft Legislation Including Part D Lock-In Language Approved by House E&C Health Subcommittee: The draft legislation breezed through a May 14 markup without amendments and now moves to the full committee for consideration, which has been scheduled for the week of May 18. Energy and Commerce Committee Chairman Fred Upton (R-Mich.), who led the 21st Century Cures initiative with Rep. Diana DeGette (D-Colo.), wants a floor vote by June and the bill enacted by the end of 2015. Several members have indicated that more changes to the bill are likely as it moves through the legislative process. Of note to community pharmacy, the legislation includes a provision that Medicare Part C and D plans must verify with providers that a beneficiary is considered at risk for prescription drug abuse before restricting the individual's pharmacy choice. At-risk beneficiaries would be those "identified through the use of clinical guidelines developed" by the Department of Health and Human Services in consultation with drug plans and other stakeholders. Those under hospice care and some in long-term care facilities could be exempted.

NCPA continues to voice concerns with the language and is working to have the provision removed or increased protections for retail and LTC patients and pharmacies included. The American Medical Association has also expressed concern that plans could lock beneficiaries into pharmacies without a meaningful consultation with the beneficiary's physician. However, PCMA, which represents pharmacy benefit managers, has praised the concept as an attempt to curb "drugstore shopping.'"

It has been recently reported that the Senate may not match the House's timeline to vote this summer on a bill, as they are producing their own bill. NCPA has also learned that there is no intention for the Senate bill to include any Medicare Part D related provisions, such as the lock-in language included in the house version.

Recap of the 2015 NCPA Annual Legislative Conference: With the 114th U.S. Congress still in its opening months, over 300 NCPA members from across the country advocated for common-sense legislative solutions to help ensure patients have access to prescription drugs and pharmacy services at the 2015 NCPA Annual Legislative Conference held this week in Washington, DC. Independent community pharmacists presented a compelling case for transparency and routine updates for generic prescription drug reimbursements by encouraging lawmakers to pass H.R. 244 (the MAC Transparency Act); urging an "any willing pharmacy" policy for Medicare Part D's "preferred" pharmacy plans through companion bills H.R. 793 and S. 1190 (the Ensuring Seniors Access to Local Pharmacies Act); and supporting better utilization of pharmacists by recognizing them as health care providers through companion bills H.R. 592 and S. 314 (the Pharmacy and Medically Underserved Areas Enhancement Act).

The conference began with a keynote speech from community pharmacist and U.S. Representative Buddy Carter (R-Ga.). It was followed by various panel discussions and policy briefings that enhanced attendees' understanding of the current governmental landscape and revealed best strategies going forward. In addition, there was a media conference call featuring U.S. Representative Doug Collins (R-Ga.), who talked about the bill he introduced in the first few days of the new Congress—H.R. 244. Attendees also heard that progress was made with regards to the recently introduced S. 1190, as over 60 organizations signed a letter endorsing the bill to the chair and ranking member of the Senate Finance Committee, which has significant health care jurisdiction.

The events culminated in a rally where attendees heard from Sens. Shelley Moore Capito (R-W.Va.) and Mike Enzi (R-Wyo.), along with Reps. Rodney Davis (R-Ill.) and Doug Collins before swarming Capitol Hill to meet directly with U.S. Senators, Representatives and their staffs, where more than 250 meetings took place. You can view photos from this week's conference on NCPA's Facebook page.

TRICARE Abruptly Changes Compound Coverage Policy: This week TRICARE officials announced details on the new direction they are taking concerning coverage for compounds. The notice outlines some of their reasoning regarding expansion of restrictions on compound claims effective May 11, 2015. On May 1st, as previously reported, TRICARE implemented an automated screening and Prior Authorization process through ESI. The new measures temporarily decreased compound costs by approximately 74% based on the previous month however, even at that reduced level, the Department's compound prescription expenditures will still average approximately $145 M per month. Some pharmacies appear to be adjusting their activities and claims to elude the newly implemented controls.

TRICARE will now immediately adopt the ESI "commercial reject list" by implementing the same program ESI has in its commercial program. If claim is rejected, the pharmacy can talk with ESI about substitute ingredients, or prescribers can request an individualized Prior Authorization review. In addition, TRICARE is initiating an audit of all compounding claims from the last 12 months to determine if recoupment is justified in cases where violations of state or federal law resulted in inappropriate reimbursement. This is a major shift from the discussion NCPA has had with TRICARE previously. We will be reaching out to TRICARE and will keep NCPA members updated concerning our activity.

PQA Membership Votes to Endorse Opioid Related Measures at Annual Meeting: The Pharmacy Quality Alliance (PQA) hosted its 10th Annual Meeting this week. NCPA is a founding member of PQA and currently has members serving on both the Measure Development Teams and Stakeholder Advisory Panels that are working to create new measures related to the quality of pharmacy and related services. Of note to community pharmacy, 3 measures related to opioid use were voted on at the meeting. Each performance measure passed and can be utilized by plans to determine patients who may be at high risk for opioid overutilization. You can view the measures here: View measures

In the States:

• Montana: S.B. 211 was signed into law by Governor Bullock on May 5th. S.B. 211 represents legislation that would take steps to increase transparency in maximum allowable cost pricing for prescription drugs.
• Oregon: NCPA submitted a letter in support of S.B. 520, which would allow a licensed pharmacist to administer immunizations to individuals aged seven and above. NCPA argued that allowing pharmacists to administer this service safely expands access to health sustaining immunizations, therefore improving access to preventative care, and decreasing future healthcare system costs. The bill has passed the House Health Care Committee unanimously and now goes to the House Floor for a full vote.
• Washington: S.B. 5557 was signed into law by Governor Inslee on May 11th. S.B. 5557 represented legislation that will address loopholes in every category of provider law and could help to ensure payment for pharmacist services that are covered for other providers. NCPA congratulates the state pharmacy association and other interest groups for their tireless efforts that made this legislation a success. SB 5557 has been supported by the Washington State Medical Association, Washington State Hospital Association, patient advocacy groups, health systems and health insurance carriers because it will result in collaborative team health care and the better utilization of the knowledge and expertise of pharmacists.
• Washington: S.B. 5441 was signed into law by Governor Inslee on May 8th. NCPA supported S.B. 5441, legislation that will allow for Medication Synchronization. This service will be provided by licensed pharmacists and help to coordinate a patient's prescribed medications for chronic conditions to allow all of a patient's prescriptions to be refilled on the same date each month.