NCPA and Partner Organizations Launch
the Coalition for PBM Reform
This week NCPA CEO Doug Hoey, along with Coalition partners, participated in a launch event for the Coalition for PBM Reform to bring transparency to the prescription drug market. The Coalition for PBM Reform, comprised of providers, patient advocates and small and large business employers, is the largest and most diverse effort yet to change the way pharmacy benefit managers operate. The members include: the AIDS Healthcare Foundation, the Coalition of State Rheumatology Organizations, the Community Oncology Alliance, FMI - Food Industry Association the National Community Pharmacists Association, and the National Federation of Independent Business. Hoey, speaking at the launch event, talked about the importance of the transparency. Saying, “There is no transparency in how PBMs price medicines, reimburse pharmacies, or determine how much patients will pay at the counter. Transparency is essential to any healthy market. There is none in the prescription drug market. Americans pay the highest drug prices in the world. And we’re the only country that has turned over prescription drugs to PBMs. We don’t think that’s a coincidence.” See NCPA’s news release here and view the recording of the launch event here.
NCPA Submits Comments to FTC
on Anticompetitive Contractual Terms
This week, NCPA submitted comments to the Federal Trade Commission (FTC) in response to a Request for Public Comment Regarding Contract Terms That May Harm Fair Competition. NPCA continues to highlight a number of issues to the FTC on the inequities of PBM market power and anticompetitive behavior when it comes to contracting with independent pharmacies. NCPA provided in depth comments on the following:
- Adhesive, take it or leave it contracts with broad confidentiality languages, non-disparagement clauses, and unfair reimbursement;
- Contractual language that can be unilaterally modified by the PBMs with little or no notice;
- Limitations on prescriptions for high-cost specialty drugs;
- Onerous data collection requirements and dubious auditing practices, which can be selective for certain pharmacies within a given network.
In response to continued abuses by the PBMs, NCPA requested the FTC issue a rule limiting terms which favor affiliated over non-affiliated pharmacies. Additionally, pharmacists from around the country provided over 2,800 comments on the impact of these anticompetitive practices on their businesses. NCPA will continue to work with the FTC to explore policies which level the playing field and ensure independent pharmacies can continue to serve patients in their communities.
NCPA, Pharmacy Times Launching New Podcast
for Independent Pharmacy Teams
The National Community Pharmacists Association and Pharmacy Times are teaming up to launch the Independent Rx Forum, a new national podcast focused on independent pharmacy issues. The first episode is now available.
A host from Pharmacy Times will be speaking monthly with NCPA staff, leadership or other independent pharmacy experts about how the industry is changing, what these neighborhood pharmacies need to stay cutting-edge and sustainable into the future, and how NCPA works to support their success. See NCPA’s press release here.
NCPA and Compounding Pharmacies Score Key Win
Against FDA in MOU Lawsuit
This week, the U.S. Federal District Court for D.C. issued a ruling for summary judgment on behalf of the compounding pharmacies who filed suit against the FDA. Earlier this year, NCPA, with financial support from the NCPA Legislative/Legal Defense Fund, filed an amicus curiae brief in support of the compounding pharmacies on behalf of our membership. In its ruling, the Court concluded the MOU is a legislative rule and subject to the Regulatory Flexibility Act – which requires executive agencies to consider the impact of their rules on small entities. The Court remanded the MOU back to the agency and now the FDA must "either certify that it will not have a significant economic effect on small businesses or prepare a regulatory flexibility analysis." However, these rulings from the Court do not require the FDA to conduct notice and comment rulemaking on the MOU so NCPA will join other stakeholders in discussions with the FDA to craft a more workable and equitable document which supports compounders and provides access for patients to their needed prescriptions.
HHS OCR Releases Resources to Assist HIPAA Entities
in Ransomware Attacks
On September 21, 2021, HHS OCR released the following materials to assist HIPAA regulated entities in preventing, detecting, and mitigating ransomware attacks. These attacks are breaches and trigger reporting requirements under HIPAA. If breached, HIPAA requires covered entities – like pharmacies - to notify potentially impacted individuals, notify the Secretary of HHS, and if more than 500 individuals are affected, provide public notice to the media. Criminals are targeting a wide variety of health care related businesses – both large and small – and gaining unauthorized access to personal health information. In response, OCR authored and collated some information on ransomware attacks:
HRSA Refers 340B Manufacturers to HHS OIG
This week, HRSA – acting on the May 17, 2021 letters requiring each manufacturer to submit a plan to the agency to come into compliance with the law with regards to contract pharmacy shipments – notified via letter each manufacturer the matter has been referred to the HHS Office of Inspector General (OIG) for their refusal to accommodate this request. The OIG will now determine whether the manufacturers are liable for overcharging for 340B drugs. The OIG can impose civil penalties of up to $5,000 for each instance of engaging in “knowingly and intentionally” overcharging covered entities. Additionally, some manufacturers have brought the matter before several U.S. federal district courts and moving through the judicial process. NCPA will continue to communicate with the stakeholders on the impacts their policy decisions have on 340B contract pharmacies.
20 Private Insurers Collect Billions from Medicare Advantage
for Incomplete Documented Patient Care
The HHS OIG published a report, released on September 22, which focused on payments generated from diagnoses submitted only on chart reviews in Medicare Advantage. The data collected focused on payments made to plans in 2017 for diagnosis submitted in 2016. 20, out of the 162 entities participating in MA, private insurers generated $5 billion in payments for patients who may not have received any additional care or services for the conditions indicated. The OIG recommended CMS take appropriate measures to increase oversight on the 20 companies which collected a significant share of the $9.2B total payments.
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. Click here for a video from NCPA President Brian Caswell outlining the safety precautions that will be in effect during the Convention.
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.