Reconciliation Stuck on a Country Road
Both the bipartisan infrastructure package and reconciliation legislation are in a state of limbo due to a standoff between moderate and progressive Democrats. The House did not vote on the trillion-dollar bipartisan infrastructure package this week as they were expected to. Speaker Nancy Pelosi delayed the planned vote as she attempted to negotiate a deal that could pass muster from both House progressives and key Senate centrists, Joe Manchin and Kyrsten Sinema. Negotiations are ongoing, but it appears likely that the proposed $3.5 trillion reconciliation package will have to shrink significantly after Sen. Manchin stated his preference for a $1.5 trillion bill.
FTC asked about unfair competition,
and you responded over 3,000 times
Thousands of NCPA members sent comments to the Federal Trade Commission describing how PBMs affect their businesses, answering a call from the commission to hear about contract terms that may exacerbate or lock in anticompetitive power disparities. In sum, NCPA members told the FTC that vertical mergers of health insurance plans/pharmacy benefit managers with retail and mail order pharmacies have been an independent pharmacy killer. NCPA CEO Douglas Hoey sent comments to FTC Chair Lina Khan, calling such mergers a “particularly pernicious example of consolidation that has resulted in substantial actual harm to competition.” Thanks to the members who took the time to send in comments. We will keep you updated on any FTC actions.
NCPA urges feds to block UnitedHealth Group’s
acquisition of Change Healthcare
NCPA has called on the Department of Justice to block UnitedHealth Group’s acquisition of data giant Change Healthcare after meeting recently with agency lawyers to warn that the merger would create an unfair competitive advantage for a company that is already dominant.
Arkansas and Illinois settle with Centene
over allegations of overcharges
The Attorneys General of Arkansas and Illinois both announced this week that their respective states have reached settlement agreements with Centene concerning allegations that the corporation had overcharged the states for administering Medicaid prescription drug benefits. Arkansas Attorney General announced a $15.2 million settlement for “overcharging [Arkansas] for medications in its Medicaid program.” Illinois Attorney General Kwame Raoul announced a $56 million settlement resolving “allegations that, as a PBM for the state of Illinois, Centene subsidiaries submitted inaccurate billing requests to the state.”
Provider Relief Fund General Distribution Phase 4 Now Open
The Provider Relief Fund (PRF) Phase 4 application process opened September 29—all applications must be submitted online in the PRF Application and Attestation Portal by October 26 at 11:59 pm (ET). The $25.5 billion in new relief funds includes $8.5 billion American Rescue Plan resources for providers who serve rural patients covered by Medicare, Medicaid, or CHIP and $17 billion for PRF Phase 4 for a broad range of providers with changes in operating revenues or eligible expenses incurred from January 1, 2020 through March 31, 2021. Details on eligibility, documentation needed, and how payments will be calculated can be found on the HRSA website here. In addition, HRSA will be hosting informational webinar sessions for Phase 4 applicants, featuring guidance on how to navigate the application portal on October 5 (register here), October 13 (register here), and October 21 (register here).
HHS directive on boosters and
important PREP Act clarification
As you have undoubtedly heard by now, HHS Secretary Becerra issued a Directive for boosters of the Pfizer-BioNTech COVID-19 vaccine following CDC recommendations. In a technical amendment to the current COVID-19 PREP Act declaration, HHS clarifies that “ACIP recommendations” and “ACIP standard immunization schedules” are in fact recommendations and schedules made by the CDC. This means that pharmacists (and qualified pharmacy technicians and interns under supervision) are authorized and protected by the PREP Act to administer a Pfizer-BioNTech COVID-19 booster shot to all populations for which CDC recommends the booster, including those ages 18 or older with increased risk of getting COVID-19 disease due to occupational or institutional exposure.
CMS to Allow Direct Billing for Vaccinating SNF Residents
with Flu and Pneumococcal Vaccine
CMS has announced that it will exercise enforcement discretion with respect to Skilled Nursing Facility (SNF) Consolidated Billing Provisions, allowing Medicare-enrolled immunizers (including but not limited to pharmacies) to bill directly and receive direct reimbursement from the Medicare program for vaccinating SNF residents with the seasonal flu vaccine and pneumococcal vaccine (including for vaccine administration and product) whether these vaccines are administered at the same time (co-administered) with a COVID-19 vaccine or if they are administered separately.
Infection Control Requirements for Pharmacy Staff
in LTC Facilities
CDC recently released an interim guidance on infection prevention and control recommendations to prevent the spread of COVID-19 in nursing homes. Per the guidance, asymptomatic fully vaccinated pharmacy staff do not need to undergo screening testing regardless of community transmission rates (state and local jurisdictions may have additional testing requirements beyond what is in the CDC guidance), but pharmacy staff and residents receiving the vaccine should also wear source control (either a NIOSH-approved N95 or equivalent or higher-level respirator or a well-fitting facemask). Additional details can be found on the CDC website here.
CMS Releases Average Premiums For MA/Part D Plans
Recently, CMS released the premiums, deductibles, and other key informationfor Part D prescription drug plans for 2022, in anticipation of the upcoming enrollment period from October 15 to December 7. The premiums will rise slight from the previous year – increasing to $33 per month, compared to $31.47 in 2021. The Part D program remains very popular with seniors, with 48 million beneficiaries enrolled in the coverage. Unfortunately, premiums are kept artificially low by PBMs by using DIR fees and do not actually result in lower prescription prices at the point of sale. Plan sponsors must factor in DIR fees as part of the bidding process, putting downward market pressure on premiums while increasing out of pocket cost for patients for their prescriptions. NCPA remains committed pursing any available avenue to reform DIR to support pharmacies and reduce the cost of prescriptions for patients.
CMS Releases Plan Preview Ahead
of Open Enrollment Period
On October 1, 2021, CMS released an online preview for 2022 Part D and Medicare Advantage plans in anticipation of the upcoming open enrollment period. The enrollment period, which is schedule to last from October 15 to December 7, permits patients to change their Part D/MA plans. NCPA will be releasing resources for pharmacy in the near future as we look ahead to 2022. Please check the NCPA website for the most up to date information related to Part D plans.
HHS Rolls Back Trump Rule on Insulin and Epinephrine
for Low Income Patients
On September 30, 2021, HHS published in the Federal Register, the withdrawal of the rule implementing Executive Order 139337, which requires certain 340B grantees to offer reduced price insulin and injectable epinephrine to low-income patients. During the initial rulemaking process, NCPA provided comments to HHS and HRSA which highlighted concerns regarding the administrative fees for these prescriptions and the potential additional regulatory burdens which might be placed on pharmacists. In finalizing the withdrawal, the Biden Administration felt the rule would have increased costs and administrative burdens for health centers – and agreed with NCPA that those costs could have been passed along to any contract pharmacies. NCPA will continue to work with HHS to ensure patient access and affordability for these important drugs.
Join Us in Charlotte, N.C. for the NCPA
2021 Annual Convention
The NCPA in person Convention is only 1 week away! 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.