NCPA Advocacy Update

Week ending May 28

Author: APCI Staff/Tuesday, June 1, 2021/Categories: Legislative Affairs

Bipartisan, Bicameral DIR Legislation Introduced

This week, new bipartisan, bicameral bills were introduced to address pharmacy DIR fees. The new legislation, S. 1909/H.R. 3554, the Pharmacy DIR Reform to Reduce Senior Drug Costs Act, was introduced in the Senate by Sens. Jon Tester (D-Mont.), Sen. Shelley Moore Capito (R-W.Va.), Sen. Sherrod Brown (D-Ohio) and Sen. James Lankford (R-Okla.). The House companion bill was introduced by Rep. Peter Welch (D-Vt.), Rep. Morgan Griffith (R-Va.), Rep. Vicente Gonzalez (D-Texas), Rep. Buddy Carter (R-Ga.), Rep. Raja Krishnamoorthi (D-Ill.), Rep. John Rose (R-Tenn.), Rep. Abigail Spanberger (D-Va.), and Rep. Diana Harshbarger (R-Tenn.). This important legislation seeks to reduce patients’ cost-sharing, prevent plans and pharmacy benefit managers from clawing back fees from pharmacies, enhance price transparency, and establish consistent pharmacy performance measures that foster quality care and that enhance the viability and predictability of pharmacy operations. NCPA issued a joint statement with several pharmacy and grocery organizations in support of the new legislation.


Chiquita Brooks-LaSure Confirmed as CMS Administrator

This week, the Senate voted to confirm Chiquita Brooks-LaSure as the Administrator for the Centers for Medicare and Medicaid Services (CMS). Five Republicans joined all 50 Democratic Senators in confirming Brooks-LaSure. The Republicans voting for the nomination were Senators Roy Blunt (R-Mo.), Richard Burr (R-N.C.), Susan Collins (R-Maine), Jerry Moran (R-Kan.), and Lisa Murkowski (R-Alaska), Senator John Kennedy (R-La.) did not vote. NCPA congratulates Brooks-Lasure on her confirmation and looks forward to working with her.


NCPA Joins Support Letter for the Pharmacy and
Medically Underserved Areas Enhancement Act

NCPA and over 100 other organizations joined together in a joint sign on letter in support of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759 / S. 1362), which would enable Medicare beneficiaries access to pharmacist-provided services under Medicare Part B by amending section 1861(s)(2) of the Social Security Act to recognize pharmacists as providers. Click here for an overview of the Pharmacy and Medically Underserved Areas Enhancement Act.


Arkansas Legislative Audit Report Notes PBM
Conflicts of Interests and Violations of Current Law

A report, requested by the Arkansas Executive Committee of the Legislative Joint Auditing Committee, was released late this week. The committee tasked the Arkansas Legislative Audit (ALA) to provide an overall perspective of how PBMs operate; determine if PBMs are complying with current state PBM regulations; determine how state funds flow through PBMs; and review complaints received by state agencies regarding PBM practices.

The report offers a comprehensive glance into the working of PBMs in Arkansas and provides, not unsurprisingly, that PBMs are not in full compliance with state law as they are still participating in the prohibited practice of “spread pricing.” Also, they found a conflict of interest arises when PBMs make formulary decisions due to rebates they receive from pharmaceutical manufacturers. Additionally, the audit found that the Arkansas Department of Insurance received a whopping 5,000 complaints from pharmacies regarding low reimbursements between 2018-2020. To address concerns highlighted in report, the ALA recommended the state legislature consider enacting legislation. Specifically, they recommended legislation to address fiduciary duty, claim payment processing times, drug rebates, conflicts of interest disclosures and additional regulation of the state Medicaid managed care program. A hearing is scheduled in June to examine the audit. The full report can be found here.


Gov. Greg Abbott Signs Texas PBM Reform Bill

Texas Gov. Greg Abbott (R) has signed HB 1763, a comprehensive PBM reform bill that unanimously passed the House and Senate last week. HB 1763 was supported by Texas community pharmacy advocates as well as NCPA, which had recently urged Gov. Greg Abbott (R) to support the legislation. Among other things, HB 1763 would:

  • Allow local pharmacies to mail and deliver prescriptions as requested by patients;
  • Prohibit pharmacy benefit manager clawbacks;
  • Ban PBMs from steering patients to PBM-owned specialty pharmacies;
  • Prohibit PBMs from paying their affiliated pharmacies more than they pay other in-network pharmacies;
  • Provide pharmacies with legal protections against retaliatory PBM actions;
  • Allow pharmacists access to their contracts from pharmacy services administrative organizations, which handle some contracting and administrative services with health insurers and PBMs on behalf of small business independent pharmacies.

HB 1763 was authored by Reps. Tom Oliverson, Cole Hefner, Eddie Lucio III, Cecil Bell, and Richard Peña Raymond. Sen. Bryan Hughes helped usher it through the Senate. The bill unanimously passed the House and Senate.


Gov. Bill Lee Signs Tennessee PBM Reform Bill

Tennessee Gov. Bill Lee (R) has signed SB1617/HB1398 sponsored by Senator Shane Reeves (R) and Representative Esther Helton (R) This legislation is a win for patients and pharmacies! The bill (among other things):

  • Prohibits PBMs from reimbursing pharmacies below their acquisition costs-this provision would apply to ERISA plan claims due to the Supreme Court’s decision in Rutledge
  • Addresses PBM conflicts of interest by prohibiting patient steering practices through means such as coercive copays
  • Prohibits spread pricing in the commercial market
  • Prohibits discriminatory payments/reimbursements for the dispensing of 340B prescriptions

Thank you to Senator Reeves, Representative Helton and the Tennessee advocates for patients and community pharmacies for all your hard work!


NCPA Joins Coalition Letter to Support Stepped-Up Basis

This week, NCPA joined more than 115 small business organizations as members of the Family Business Estate Tax Coalition on a letter to the Chairman and Ranking Member of the Senate Finance and House Ways and Means Committees. The letter expresses unequivocable support for the continuation of stepped-up basis and protecting family-owned businesses from tax increases.


Biden Administration Releases FY2022 Budget

President Biden released the FY2022 Budget – which provides a road map for the policy priorities for the upcoming fiscal year. The budget – with a topline of $6 trillion dollars - covers all discretionary spending but is dependent upon the adoption by Congress and funds appropriated by the corresponding committees. Of interest to NCPA members, President Biden offers support for prescription drug reform – encouraging Congress to pass legislation to allow CMS to negotiate drug prices and have manufacturers rebate costs on drugs that rise in price faster than inflation. While the FY2022 budget provides only a brief glimpse into the mindset of the Administration on drug pricing issues, NCPA will advocate CMS and Congress to adopt policies which positively impact community pharmacy.


HHS Adds $4.8B to HRSA Uninsured Program

The Department of Health and Human Services (HHS) has announced that it will dedicate $4.8 billion from the American Rescue Plan to the COVID-19 Uninsured Program specifically to reimburse providers for testing uninsured individuals for COVID-19 through the COVID-19 Uninsured Program Portal. Pharmacies can be reimbursed for the provision of COVID-19 services, testing, treatment, and vaccine administration to uninsured individuals through the program. It is important to note that this program functions like a medical benefit, rather than a pharmacy benefit, and that payment is expected to be the same as Medicare rates for each service. Pharmacies will need to enroll in the program and then work with their medical intermediary to submit claims for reimbursement. Additional information regarding the program can be found on the HRSA website here.


NCPA Submits Comments to FDA
Pharmacy Compounding Advisory Committee

On May 26, 2021, NCPA submitted comments regarding the upcoming June 9, 2021 Pharmacy Compounding Advisory Committee (PCAC) meeting. At this meeting, the FDA is proposing to discuss several substances (oxitriptan, melatonin, methylcobalamin, and choline chloride) to potentially add to the 503A Bulk List and one (Neomycin Sulfate) for the Withdrawn or Removed List. During previous opportunities before FDA and the PCAC, NCPA has supported the addition of oxtriptan, melatonin, and methylcobalamin to the List – and the FDA supports the addition of oxitriptan and melatonin for this round. NCPA’s response focuses on the importance of compounding with methylcobalamin which has seen success in the treatment of Autism Spectrum Disorder (ASD). During the actual meeting, NCPA will be represented before the PCAC regarding the importance of methylcobalamin for our membership.


NCPA State Legislative Activity Update

NCPA tracks state legislation related to our top three state priorities: Medicaid reformscope 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.

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