NCPA Advocacy Update

Week ending June 4

Author: APCI Staff/Monday, June 7, 2021/Categories: Legislative Affairs

CMS Data Shows Pharmacy DIR Fees
Increased 91,500% from 2010-2019

CMS and HHS released a joint statement to further explain the Administration’s requests for appropriated funds as part of the appropriations process. The agencies recognized the impact of DIR fees and price concessions on the increasing cost of drugs in Medicare Part D stating: “pharmacy price concessions, net of all pharmacy incentive payments, grew more than 91,500 percent between 2010 and 2019.” CMS also reiterates that it will be working on the specifics of the rule requiring the disclosure of pharmacy performance measures, which NCPA commented on, by January 1, 2022. NCPA will continue to advocate for CMS and Congress to address DIR fees through regulatory and legislative action, including advocating for passage of S. 1909/H.R. 3554, the Pharmacy DIR Reform to Reduce Senior Drug Costs Act. View NCPA’s news release on CMS’ data here.


FTC Issues Report on Effects of PBM Rebates

The FTC recently released a report on PBM rebates. Among the findings in the report, the FTC noted that rebate walls “may give payers strong incentives to block patient access to lower-priced medicines, whereas absent rebates a lower-priced equally effective product would tend to take sales from the higher priced incumbent product.” Additionally, FTC Commissioner Rohit Chopra released a statement reacting to the report stating in part, “The FTC and Congress must take concrete steps to address the conflicts of interests embedded in the structure of the PBM industry. In addition to problematic rebating practices, we must also examine whether PBMs are engaged in coercive practices that harm patients, independent pharmacists, and public health.” NCPA has raised concerns about PBM consolidation and practices for many years. Read NCPA’s full news release on the report here.


NCPA Joins Pharmacy Groups to Welcome
HHS Deputy Secretary

In a joint letter to Andrea Palm, the recently appointed Deputy Secretary at the Department of Health and Human Services (HHS), the groups highlighted the critical role of pharmacists as frontline workers in a variety of settings. It also called attention to the need to retain pharmacist patient care authorities and flexibilities provided during the COVID-19 public health emergency, reimburse pharmacists under Medicare Part B for providing equivalent services to other health care providers, address pharmacy DIR fees, and to utilize the unique expertise and perspective of pharmacists to achieve health equity goals.


Court Delays HRSA Enforcement of 340B Drug Pricing

Last week, the Court delayed the enforcement of a June 1, 2021, deadline for Eli Lilly to provide 340B pricing to contract pharmacies or face fines to June 10, 2021. The judge denied a temporary restraining order to halt the enforcement by HRSA but did grant the nine-day extension for the company to respond to the letter sent by the agency to noncompliant drug manufacturers. Currently, there are multiple legal challenges involving the 340B drug pricing program – particularly the usage of contract pharmacies by the covered entities – and the capability of HRSA to enforce certain aspects of the program. NCPA will continue to consult with membership on how these disputes are affecting them and work to ensure continued access for their patients.


Court Strikes Down Medicaid Managed Care Implementation
in Oklahoma

The Oklahoma Supreme Court ruled that the Oklahoma Health Care Authority does not have the legislative authority to implement a Medicaid managed care plan. The ruling puts a stop, for now, to Gov. Kevin Stitt’s (R) push to move the state’s Medicaid beneficiaries to a managed care system. The decision will likely benefit Medicaid beneficiaries and community pharmacies alike, as patients will continue receiving benefits through the transparent fee-for-service program, rather than the managed care system in which PBMs have control over the prescription drug benefit.


Federal PBM Transparency Legislation Introduced

This week, U.S. Representatives Abigail Spanberger (D-Va.) and Jodey Arrington (R-Texas) introduced H.R. 3682, the Improving Transparency to Lower Drug Costs Act. This legislation is a step forward in holding PBMs accountable by requiring PBMs to report their aggregate pharmacy DIR fees, rebates, discounts, and other price concessions for prescription drugs to a public website. NCPA is proud to endorse this legislation. More information on the legislation can be found in this press release.


California Patient-Steering Bill Passes in the Senate

California SB 524 unanimously passed the Senate and is headed to the Assembly. The bill prohibits PBMs from using misleading advertisements to steer patients to specific pharmacies. NCPA was proud to submit written and oral support for the bill while it was considered in committee.


Help Patients Fight Back Against PBM Steering

NCPA has developed materials that you can use in your pharmacy to help your patients fight back against PBM steering. These materials direct your patients to the resources available to them on Fight4Rx such as sample letters and who they can contact to express their dismay at being steered away from your pharmacy by a PBM. Contact Michael Rule at mrule@ncpa.org with any questions.


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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