NCPA Welcomes New Chair of FTC… Requests Focus
on PBM Anticompetitive Practices
In a welcome letter to Lina Khan, NCPA congratulated the new Chair of the Federal Trade Commission (FTC) on her recent appointment and requested continuing to focus the agency on the harms of vertical integration in healthcare. In the letter, NCPA highlighted the negative impacts on community pharmacy of consolidation in the healthcare marketplace through the following: anticompetitive contracting practices which favors corporate owned pharmacies; patient steering to mail order pharmacies owned by PBMs; conflicts of interest in establishing formularies and reimbursement; and pharmacy deserts arising as a result of anticompetitive behavior of PBMs. NCPA hopes to continue to dialogue with the agency on these important issues and ways to address them through existing FTC authorities.
NCPA Submits Comments to FTC Pharmaceutical Merger
Task Force Asking to Expand Focus
NCPA submitted comments in response to a request for public input for a multijurisdictional and international task force being led by the Federal Trade Commission (FTC) focused on the effects of pharmaceutical mergers. The task force is seeking input on exploring new or refreshed theories of harm to address all anticompetitive effects from pharmaceutical mergers, acquisitions, joint ventures, and consolidation. The comments submitted by NCPA requested the task force expand the scope of review to include other vertical integration and consolidation in the healthcare sector. NCPA highlights the anticompetitive behavior of PBMs and the negative impacts on both community pharmacy and patients. NCPA requests the task force and the FTC continue their investigation on “rebate walls” and the conflicts of interest inherent in formulary placement. NCPA will continue to work with FTC and other agencies with jurisdiction on antitrust issues to ensure proper and timely investigations of conduct undertaken by the PBMs.
NAIC Advances PBM White Paper and Model Legislation
with NCPA Input
The National Association of Insurance Commissioners’ Health Insurance and Managed Care (B) Committee approved a charge for its Pharmacy Benefit Manager Regulatory Issues (B) Subgroup to develop a white paper addressing PBMs’ role in the prescription drug supply chain and examining state provisions addressing various PBM practices. The committee also advanced model legislation to regulate and license PBMs, which next moves before the full NAIC at its summer meeting in August. NCPA has made it a priority to work with NAIC throughout the years-long process and educate its members on the effects of PBMs on pharmacies, patients and payers/taxpayers. Click here for NCPA’s news release.
Senate Releases Principles for Lowering Drug Prices
Senate Finance Committee Chairman Ron Wyden (D-Ore.) released a document outlining his priorities for lowering prescription drug prices as Congress continues its legislative work to provide relief from high drug prices. Senator Wyden has been working to craft a bill to lower drug prices and this is the first written indication of what Senate Democrats want. The document calls for Medicare to be able to negotiate lower drug prices, a restructuring of Medicare Part D to reduce out-of-pocket spending, and to extend drug pricing reforms beyond Medicare. While the document does not supply details on how to achieve these goals, it does highlight the distorting effect of PBMs on drug prices and calls for greater transparency, as well as acknowledging that the “Rebate Rule” proposed by the previous administration does not properly address the problem of high prices and that Senate Democrats will seek to block the rule.
Senate Republicans Introduce Own Drug Pricing Bill
This week, Senate Finance Committee Ranking Member Mike Crapo (R-Idaho), Senate HELP Committee Ranking Member Richard Burr (R-N.C.) and six Senate Republicans introduced the Lower Costs, More Cures Act. This legislation is the Senate Republican drug pricing proposal. It is similar to H.R. 19, the House Republican drug pricing proposal, including policies impacting Medicare Parts B and D and Medicaid. Notably, the bill establishes a $3,100 out of pocket cap for Part D enrollees and requires Part D plan sponsors to only use pharmacy quality measures established or adopted by the Secretary. However, the Senate bill does not include the Medicaid managed care spread pricing prohibition that is included in the House companion legislation.
Use the Upcoming July 4 Congressional Recess
to Promote Pharmacy DIR Reform
Congress will be in recess July 2-July 11 in observance of the July 4 Holiday. Many members will be home in their districts meeting with constituents. This is an ideal time to invite your member of Congress to tour your pharmacy and urge their support for S. 1909/H.R. 3554, the Pharmacy DIR Reform to Reduce Senior Drug Costs Act. Click here for tips on scheduling a pharmacy visit or contact Michael Rule at mrule@ncpa.org for assistance.
If you are unable to meet with your legislators, they still need to hear from you! Click here to send them an email urging them to cosponsor this critical legislation.
Pharmacy Groups Highlight Priorities
for New CMS Administrator
In a joint letter to Chiquita Brooks-LaSure, NCPA and other pharmacy groups congratulated the new Administrator of the Centers for Medicare & Medicaid Services (CMS) on her recent appointment. In the letter, pharmacy groups highlighted the essential role of pharmacies and particularly the critical contributions of pharmacists during the ongoing COVID-19 pandemic, and shared the following recommendations with CMS: 1) retain pharmacist patient care authorities and flexibilities provided during the COVID-19 public health emergency; 2) utilize pharmacists’ expertise to achieve health equity goals; 3) reimburse pharmacists under Medicare Part B for providing equivalent services to all other health care providers; 4) support the Pharmacy and Medically Underserved Areas Enhancement Act; and 5) eliminate direct and indirect remuneration (DIR) fees.
NCPA Supports Provider Status Legislation
in Statement to Senate HELP Committee
This week, NCPA urged the Senate to pass provider status legislation, S. 1362 - the Pharmacy and Medically Underserved Areas Enhancement Act at a hearing of the Senate Health, Education, Labor, and Pensions Committee. We pressed Congress to make permanent many authorities and flexibilities granted to pharmacies during the COVID-19 Public Health Emergency. The hearing, Vaccines: America’s Shot at Ending the COVID-19 Pandemic, focused on ways to promote vaccinations. Committee Chair Patty Murray (D-Wash.) and other Democrats emphasized the importance of getting vaccines to underserved communities and supporting trusted community leaders to improve vaccine confidence. Ranking Member Richard Burr (R-N.C). focused on breaking barriers to vaccinations.
NCPA Joins Letter Opposing Changes
to Qualified Business Income Reductions
This week, NCPA joined over 100 other small business advocacy organizations on a letter to the Chairmen and Ranking Members of the Senate Finance Committee and House Ways and Means Committee to voice opposition to proposed changes to deduction for qualified business income. Currently, there is a 20% deduction for qualified business income. The letter noted that “Proposals to limit or repeal the deduction would hurt Main Street businesses and result in fewer jobs, lower wages, and less economic growth in thousands of communities across the country.”
HHS Withdraws 340B Advisory Opinion
HHS withdrew an advisory opinion on the use of contract pharmacies in the 340B program – citing the “need to avoid confusion and unnecessary litigation.” However, HHS has not changed its stance on the actions of the manufacturers nor withdrawn the demand letters sent to each manufacturer requiring them to provide 340B discounted drugs to all contract pharmacies without restriction. However, there still remains a legal question before the Courts where manufacturers have filed disputes of whether HHS has the authority to operate a contract pharmacy program – as the 340B statute is silent on contract pharmacies- and whether the manufacturers have the ability to restrict sales to those entities unilaterally. NCPA will continue to work with other stakeholders participating in the 340B program to ensure patient access to discounted drugs is not impeded.
NCPA Defends Compounding as FDA Hosts Listening Session
This week, NCPA staff and several members participated in the yearly FDA Listening Session. There was a free-flowing dialogue with the FDA covering several topics including the MOU, adverse event reporting, drug shortages, and office use – among others. The FDA was open during the discussion and enjoyed hearing from our members – Dr. A.J. Day and Dr. Jeff Carson – who were able to provide a unique perspective. NCPA will be following up with formal written comments on those discussion topics as well as other matters unable to be debated due to time.
Join Us in Charlotte, N.C. for the NCPA
2021 Annual Convention
If you have not yet done so, register for the in-person NCPA 2021 Annual Convention in Charlotte, N.C. from Oct. 9-12. Don’t miss the chance to reconnect with your colleagues for four days of best-in-class business education, networking opportunities, and a little fun in Charlotte. We look forward to seeing you there.
Second PBM Reform Bill Becomes Law in Texas
Texas HB 1919 became law last week. The bill prevents PBM self-dealing by prohibiting them from steering patients to affiliated pharmacies. It is the second PBM reform bill to become enacted recently in Texas. Gov. Greg Abbot recently signed HB 1763, which unanimously passed the House and Senate. That bill prohibits retroactive claim reductions, protects patient choice and access to community pharmacy services, and prevents PBMs from requiring onerous specialty accreditations. Congratulations to all community pharmacy advocates in Texas!
OSHA Releases New Requirements for Health Care Settings
OSHA released an emergency temporary standard to reduce the risk that healthcare workers may contract COVID-19 in the workplace. While the new requirements do not apply to pharmacists dispensing prescriptions in a retail setting, they do apply to any setting that offers COVID-19 testing. If you offer COVID-19 testing, whether in a space inside your pharmacy or outside in a temporary structure (i.e., tent), you will be responsible for implementing certain requirements. In addition, while the requirements do not apply to closed-door LTC pharmacies, pharmacies located within LTC facilities will need to comply with requirements, although the responsibility for implementation will generally be on the facility operator. You’ll find details here. If you have any questions or concerns, contact your local OSHA office or Shion Chang at Shion.chang@ncpa.org
NCPA Provides Legal Update to Florida Society
of Rheumatology
NCPA presented at a meeting of the Florida Society of Rheumatology (FSR) regarding the landmark decision in PCMA v. Rutledge. NCPA discussed the significance of the 8-0 ruling, which confirmed that states may regulate abusive PBM practices and that such regulations are not preempted by ERISA. NCPA also discussed the amicus curie brief it will be filing in PCMA v. Wilke, a related matter currently pending before the 8th Circuit Court of Appeals, and how continued federal victories will help curb the significant power wielded by PBMs to the detriment of healthcare plans, pharmacies, and patients.
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.
Due to the holiday, there will not be an Advocacy Center Update on July 2. It will resume on July 9.
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.