Judge Rules that Washington State’s Medicaid
Reimbursement Plan Violates Medicaid Rules
In a win for community pharmacy, an administrative law judge issued a rulingrecently confirming that Washington state’s pharmacy reimbursement plan violates Medicaid rules. The finding upholds CMS’ March 2019 decision to this effect, which was challenged by Washington State. The action arises from a 2017 lawsuit filed by NCPA, the National Association of Chain Drug Stores and the Washington State Pharmacy Association against the state of Washington and brings the case a step further to closure. For background on the case, see this press release.
President-elect Biden Selects COVID Response Leads
President-elect Joe Biden has reportedly selected Jeff Zients, co-chair for the Biden transition and a former Obama administration official, to as the White House’s COVID-19 coordinator. Additionally, Vivek Murthy, who previously served as U.S. Surgeon General in the Obama administration will return to that role, but with broader responsibilities. A formal announcement of these appointments could come as early as this weekend.
Rep. McMorris Rodgers to Serve as Ranking Member
of Energy and Commerce Committee
This week, House Republicans selected pharmacy champion Rep. Cathy McMorris Rodgers (R-Wash.) to serve as the Ranking Member of the House Energy and Commerce Committee for the 117th Congress. Next year she will make history when she becomes the first woman from either party to assume a top spot on the committee. The Energy and Commerce Committee has jurisdiction over much of pharmacy’s legislative agenda and McMorris Rodgers has been a staunch supporter for many years. NCPA congratulates McMorris Rodgers on her selection and looks forward to continuing to work with her.
NCPA Signs onto Coalition Letters
on Paycheck Protection Program
This week, NCPA joined as signatories on two coalition letters pertaining to the Paycheck Protection Program (PPP). In the first letter addressed to House and Senate leadership, NCPA joined over 560 other organizations in calling on Congress to overturn IRS 2020-32 and allow PPP loan forgiveness to be fully tax-free. In the second letter, also addressed to House and Senate leadership, NCPA joined 95 other organizations in urging Congress to authorize a second draw of PPP loans. Additionally, the letter calls on Congress to enact full tax deductibility for PPP loans and to simplify forgiveness of loans totaling less than $150,000. Improvements to the PPP is one of NCPA’s essential priorities for the next COVID relief package.
CMS Releases Medicaid Vaccine Toolkit
The Centers for Medicare & Medicaid Services’ (CMS) recently released a toolkit - Coverage and Reimbursement of Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program. This toolkit intends to provide clarity about the various options available for the respective Medicaid agencies to address challenges and red tape in the way of increasing the public’s access to the COVID-19 vaccines, once approved. The main takeaway is states have options and significant discretion to ensure coverage of the COVID-19 vaccine and administration fee. See NCPA’s Summary for more details.
Florida Releases Report on State’s Medicaid PBMs
The Florida Agency for Health Care Administration released a report on the PBMs utilized in the state’s Medicaid managed care programs. Among other findings, the report found that PBM-owned pharmacies are reimbursed more than non-affiliated pharmacies for generic specialty drugs, thus highlighting the need to stem PBM conflicts of interest. There are some findings that appear not to align with the findings of other states, such as Ohio and Kentucky, that have similarly investigated their PBMs. We are still combing through the data, and NCPA will have a more comprehensive analysis of the report in the coming days.
CMS Releases Final Medicaid and CHIP Rule
CMS announced the final Medicaid Managed Care and CHIP rule. Among those changes that may have the largest impact on community pharmacies are changes to provisions addressing state-directed payments, enrollee encounter data, network adequacy standards, and the quality rating system. NCPA has created a summary with more information.
CMS Formally Delays EPCS Enforcement One Year
On December 1, 2020, as part of the CY 2021 Physician Fee Schedule (PFS) final rule, CMS announced a delay in enforcement of the EPCS mandate established in the SUPPORT Act to January 1, 2022. While CMS did finalize the original January 1, 2021 deadline for adoption for prescribers, the agency is delaying compliance while it continues to develop the rulemaking for the waivers and enforcement processes required. CMS is encouraging prescribers to adopt the EPCS standard as soon as possible while the agency continues to utilize stakeholder feedback to establish penalties and waivers. Additionally, under the SUPPORT Act, neither pharmacies nor Part D plans are responsible for verifying if the prescriber is EPCS compliant or has a waiver for exemption. NCPA submitted comments to the RFI regarding implementation of the long-term care (LTC) pharmacy exemption as well as the PFS.
Pennsylvania Medicaid Reforms Signed into Law
Governor Tom Wolf (D) signed HB 941, which reforms the commonwealth’s Medicaid managed care program to protect beneficiaries, taxpayers, and local community pharmacies. Under the newly signed act, PBMs in the Medicaid program are prohibited from arbitrarily excluding a pharmacy from network participation, retroactively denying or reducing claim reimbursements, charging hidden pharmacy transmission fees, mandating that a Medicaid patient use the pharmacy of the PBM’s choice, and engaging in the costly practice of spread pricing. Additionally, the act requires the Legislative Budget and Finance Committee to conduct a study analyzing PBM reimbursement practices and other information impacting prescription drug pricing in the Medicaid program.
NCPA Submits Comments to CMS
on Parts C and D Payment Policies
NCPA submitted comments to the proposal put forth by CMS with a focus on Part D Star Ratings and updates to pharmacy measures. In lieu of the traditional call letter process during the PHE, CMS has been moving forward with updates for the upcoming calendar years for Part C and Part D programs in piecemeal fashion. In this update, CMS is proposing additional flexibility in the Star Ratings system. NCPA supports the changes to the PQA metrics of SUPD and Poly-CNS to provide more accurate data as well as returning the DDI, APD-Comm, and OHDMP metrics to display measures for ratings purposes. These changes were also supported by PQA. NCPA cautioned CMS on issues related to COVID-19 immunization measures and their implementation in the Star Ratings.
NCPA Comments to DEA on Administrative Hearing Changes
NCPA submitted comments to the Drug Enforcement Administration (DEA) in response to a proposed rule on changes to default provisions for hearing proceedings related to the revocation, suspension, or denial of a DEA registration. NCPA recommended: 1) the current 30-day deadline to request a hearing in response to an order to show cause (OSC) remain in place; 2) an extension of the current 30-day deadline to file a substantive response material to an OSC to 60-days; and 3) for any change to the current deadline to be delayed until the end of the COVID-19 public health emergency.
NCPA Expresses Concerns with Oregon Senate Bill 698
to Governor and Board of Pharmacy
NCPA expressed concerns with Oregon Senate Bill 698 in letters to Governor Kate Brown (D) and the State Board of Pharmacy. Senate Bill 698, which passed in 2019, requires community pharmacies to have special prescription container labels in both English and at least 14 readable languages for patients with limited English proficiency (LEP) starting January 1, 2021. In the letters, NCPA expressed concerns over the fiscal impacts the bill will have on community pharmacies and urged a delay in implementation.
NCPA Joins Allied Organizations on Joint Comments
to D.C. Health and Board of Pharmacy
NCPA, NACDS, NGA, and FMI submitted joint comments to DC Health and Board of Pharmacy highlighting the restrictive measures of the proposed ruling for COVID-19 testing by pharmacists. The letter asks for a broad standards of care approach, including referencing the Centers for Disease Control (CDC) and Prevention’s national infection control guidelines for PPE requirements, allowing pharmacy flexibility on testing locations, indoor, outdoor or at an offsite location, and removing the requirement for scheduling appointments before testing. These recommendations aim to positively impact patient access while maintaining the highest standard of care.
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