Ad Campaign Shines a Light on PBMs
NCPA is teaming up with multiple state pharmacy associations on a campaign to promote the value of pharmacies in ensuring patient access to reliable, affordable health care. The campaign also aims to educate the public, patients, and policymakers on the largely unknown role played by PBMs, in raising drug costs, restricting patient access, and squashing local pharmacies, ultimately limiting consumer choices. Access to pharmacies – essential businesses and health care providers – has never been more important than in the past year, NCPA CEO B. Douglas Hoey said in a statement.
The Truth Campaign is active in 18 states and responds to PCMA’s attacks on community pharmacies that attempt to distract from the role PBMs play in increasing drug costs. There are free resources available that can be used in the pharmacy and on social media to raise awareness of PBM practices with your patients and community and inform them of how PBMs are increasing their drug costs and limiting their access to the pharmacies of their choice.
For more information on the campaign, please visit this website or watch this video.
Pharmacies Groups Urge CMS to Reconsider Approval
of Washington State’s Flawed Medicaid Reimbursement Plan
In a letter to CMS, NCPA joined NACDS and the Washington State Pharmacy Association (WSPA) urging them to reconsider its reversal of their previous decision to disapprove a flawed Medicaid reimbursement plan. In a surprising reversal, CMS approved a Washington State Medicaid reimbursement plan which includes a Medicaid dispensing fee well below neighboring states and the national average. In March 2019, CMS disapproved the state’s Medicaid reimbursement, and Washington filed an appeal. In November of last year, an administrative law judge also ruled that Washington State’s Medicaid reimbursement plan violates Medicaid rules. NCPA joined NACDS and WSPA in a letter to CMS asking that CMS adopt this decision so Washington State is required to resubmit a state plan amendment that includes an appropriate dispensing fee. In the waning moments of the Trump Administration, CMS reversed their original decision, and with little explanation, approved this flawed Medicaid reimbursement that could potentially reimburse pharmacies well below their costs. NCPA, NACDS and WSPA collectively filed a lawsuit against the State of Washington several years ago and are determining next steps to address this unfair and nonsensical decision by CMS.
NCPA Joins Coalition Letter to Preserve
Net Operating Loss Relief
Last week, NCPA joined over 80 other organizations on a letter addressed to Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Mike Crapo (R-Idaho) urging them to reject calls by members of Congress to retroactively repeal last year’s Net Operating Loss (NOL) relief enacted in the CARES Act. As noted in the letter, repealing this provision would result in a retroactive tax hike on thousands of businesses who already suffered losses in the previous year. NCPA will continue to advocate against policies that would adversely impact small business community pharmacies.
NCPA Releases Summary of Healthcare Provisions
in Appropriations Bill
This week, NCPA released a summary of the healthcare provisions in the latest enacted COVID-19 relief package passed by Congress and signed into law by President Trump. On December 21st, 2020, Congress passed, and President Trump subsequently signed on December 27th, 2020, the Consolidated Appropriations Act, 2021, which includes numerous authorizing provisions, beyond the small business provisions included in an earlier summary, which might have an impact on pharmacy and the healthcare industry. NCPA authored this high-level summary of relevant provisions for the information of community and long-term care pharmacies. NCPA will continue tracking relevant legislation as Congress drafts and enacts further policy changes and federal response to the ongoing public health emergency.
2021 Special Enrollment Period for Marketplace Coverage
in Response to COVID-19 Opens February 15
The Centers for Medicare & Medicaid Services (CMS) announced in a press release that the Special Enrollment Period (SEP) for the Health Insurance Marketplace will officially be available to individuals and families in 36 states that use the HealthCare.gov platform beginning Monday, February 15 and run through Saturday, May 15, 2021. This announcement is in accordance with an Executive Order issued on January 29, 2021 by President Biden as a first step towards pursuing health equity. More information regarding the SEP can be found in this CMS fact sheet.
NCPA Joins Pharmacy Groups in Opposing CMMI Changes
for Part D Payment Modernization (PDM) Model
NCPA joined several other pharmacy groups in a letter to the Acting Administrator and Director of CMS requesting revisions to the PDM model in the closing days of the Trump Administration be rescinded. These changes would remove protections in the Part D program – removing the requirements for coverage of the six protected drug classes and providing for at least two drugs in each class. The organizations believe that providing legitimacy for this model will not result in lower drug costs but negatively impact minority patients and further increase the ability of PBMs and health plans to interject into patient care.
FDA Warns of Compounding Remdesivir
The FDA is warning against the compounding of remdesivir, a treatment for COVID-19, due to the active pharmaceutical ingredient’s risks by 503A facilities. While the drug, under the brand name Veklury, is approved for use, the FDA encourages compounders to avoid it as the API is complex and does not have a USP monograph or another public quality standard available. NCPA will continue to monitor the FDA’s activity on this matter should the situation and the need for the drug change.
Minimize Audit Liability for COVID-19 Vaccination
The recent announcement that community pharmacies will start receiving COVID-19 vaccine this week through CDC’s Federal Retail Pharmacy Program for COVID-19 Vaccination means that pharmacies should review NCPA’s reimbursement pathways handout. One unique aspect of COVID-19 vaccine administration reimbursement is that some payers reimburse the second dose higher than the first dose. Limit your audit liability by only using Submission Clarification Code – 06 for the second dose. If you did not administer the first dose, it’s a good idea to document any sources (e.g., vaccination card, IIS) used to verify the first dose. NCPA is collecting information to help identify broad systemic issues with the billing of COVID vaccines. Please submit any examples you have on such billing issues here.
NCPA Submits Letters of Support
for Hawaii, Indiana Legislation
NCPA submitted letters of support for SB 602 and SB 975, both from Hawaii, and SB 143 from Indiana. In Hawaii, SB 602 would prohibit spread pricing and enact other transparency measures, and SB 975 would establish fair pharmacy audit requirements. In Indiana, SB 143 would strengthen existing PBM regulations by requiring PBM reimbursements to reflect true market costs.
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. The weekly update is intended exclusively for the recipient and is not for external distribution.