NCPA President Brian Caswell Talks
PBM Steering Issues With FTC

NCPA President Brian Caswell spoke to the Federal Trade Commission during its open meeting this week about anticompetitive PBM issues as NCPA continues to educate and collaborate with the FTC and others on the need for antitrust oversight. Caswell spoke about patients who were forced to abandon the local pharmacy and steered toward a PBM-owned retail pharmacy or mail-order. A national survey in February 2021 found that 85 percent of American adults prefer to get their prescription drugs from a local pharmacist instead of a mail order service, mainly because of the personal relationship. Read the full text of Caswell’s remarks here.

West Virginia to PBMs: Follow the Law or Lose Your License

The West Virginia Offices of the Insurance Commissioner (OIC) released a bulletin putting PBMs and health benefits plans on notice about recent changes to the state’s pharmacy provider network adequacy requirements. West Virginia’s freedom of consumer choice law prohibits a PBM from requiring a patient to utilize a mail-order pharmacy. It has come to OIC’s attention that some plans/PBMs have created sub-networks for specialty drugs that consist only of mail-order pharmacies. In the bulletin, OIC makes clear that these mail-order only sub-networks deprive patients of the freedom to choose pharmacy providers in violation of the law. There are no exceptions to the law, and even those PBMs serving ERISA plans are subject to its provisions. The consequences for continuing these mail-order only sub-networks are severe, as OIC is legally prohibited “from approving the licensure of any PBM or approving any health benefit plan that does not conform to the freedom of consumer choice for pharmacy provisions.”

House Committees Move Forward with
the Budget Reconciliation Process

House Ways and Means and Energy and Commerce Committees marked up their portions of the $3.5 trillion budget bill moving the Reconciliation process closer to a full House vote. However, the legislation reported out of committees this week was solely a product of the House, not legislation that Senate Democrats or the White House had consulted on. Democrats still must sort out how to pay for the package, and some moderates are trying to slow down the process. Regardless of what package the full House of Representatives passes, there will still have to be comprises made with the Senate. Senate committees, like the Senate Finance Committee will likely release their budget priorities sometime next week and the budget negotiations will go on well into October. While Congress continues to work on its final bill, NCPA is making a full push through social media, digital advertising, and grassroots to for inclusion of a top priority for community pharmacy: eliminating pharmacy benefit manager spread pricing under the Medicaid program and to reimburse pharmacies in a fairer and more transparent manner.

NCPA Calls Out PBMs in Ad Campaign

This week, NCPA launched a three-day ad blitz aimed at pushing Congress to end the shady practices of giant corporate middlemen who pocket savings intended for senior citizens and drive local pharmacies out of business. The ad, You Should Know, shows PBMs negotiate discounts on expensive pharmaceuticals and keep a chunk of the savings instead of passing it on to consumers. The ad also points out how the same PBMs steer patients to their own pharmacies – and away from local independent pharmacies – to limit patient access. The ad will appear in The Washington Post today and Wednesday and in Politico today through Thursday.

NCPA Joins Small Business Coalition Opposing Tax Increases
on Small and Family-owned Businesses

NCPA joined over 160 other small business organizations, as members of the Family Business Estate Tax Coalition (FBETC), on a letter to Chairman Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) of the House Ways and Means Committee, urging them to preserve the current protections from increased taxes on family-owned businesses. The letter communicated our unequivocal support for the continuation of stepped-up basis. Stepped-up basis prevents family-owned businesses from being hit with two significant and damaging tax bills when a family member passes away — the capital gains tax on any appreciated assets and the estate tax on whatever is left. Further, we communicated our opposition to any changes to stepped-up basis that would impose this double death tax and increase taxes on family-owned businesses and farms. NCPA will continue to advocate against increased taxes on small and family-owned business as the budget reconciliation makes its way through the legislative process. A copy of the letter can be found here.

NCPA Comments to CMS on Physician Fee Schedule

NCPA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to their calendar year 2022 Medicare physician fee schedule proposed rule. NCPA comments focused on pharmacist scope of practice issues, pharmacist payment for COVID-19 and preventive vaccine administration in Medicare beneficiaries’ homes, pharmacist provided telehealth services, Electronic Prescribing for Controlled Substances (EPCS) in LTC facilities and extending current flexibilities in the Medicare Diabetes Prevention Program (MDPP) beyond the COVID-19 public health emergency.

NCPA Resource Helps Find State Laws
Addressing PBM Oversight

A new NCPA resource can help you determine how your state protects your pharmacy and patients from PBM abuses. The spreadsheet lists common PBM oversight provisions and lists the states that have enacted such a provision, along with the statutory cite. The information includes laws addressing PBM oversight, provider networks, reimbursement issues, and conflicts of interest.

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.

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.