CMS States Intention to Address Pharmacy DIR
in Rulemaking
Earlier this week, CMS notified via letter sponsors of legislation to fix pharmacy DIR fees in Congress, including Rep. Buddy Carter (R-Ga.) and Sen. Jon Tester (D-Mont.), that they would be using the rulemaking process to address the issue. Politico (login required to access the article), reported on the development and quoted Karry LaViolette, NCPA Senior Vice President of Government Affairs, in the article “How do you run a business without knowing, sometimes for months, if you break even, make some profit, or take a loss on a transaction.”
NCPA eagerly awaits the final clearance and publication of the Part D rule for Contract Year 2023 (that is a likely vehicle for CMS to use) in the Federal Register to know exactly what policies CMS will be implementing to finally resolve this issue.
CMS Issues Medical at Home Guidance
This week, due to NCPA’s persistent advocacy CMS issued guidance to clarify that Part D dispensing fees can include additional costs for specialized services typically provided in the institutional care setting, such as delivery and special packaging, for enrollees residing in their homes with institutionalized level of care needs. Recognition and payment for medical-at-home services has been the No. 1 priority for the NCPA LTC Division, and this is certainly an early Christmas gift from CMS to LTC pharmacies. There is still much work to do, but this is a great first step. Join NCPA’s LTC Division to stay up to date on the latest developments and to be engaged in the efforts. Read NCPA’s news release here.
End of Year Deadline for SBA COVID-19 EIDL
The Small Business Administration will no longer be accepting new applications for COVID-19 Economic Injury Disaster Loan (EIDL) past December 31, 2021. In addition to normal EIDL loans, there is a separate COVID-19 related fund to assist small business owners. An applicant can receive a maximum of $2M, which can be repaid over a period of 30 years. Payments can be deferred for 2 years and the loan carries an interest rate of 3.75%. Interested pharmacies can apply here.
NCPA Melts the Phones to End DIR
NCPA continued its campaign to Melt the Phones on Capitol Hill to demand inclusion of pharmacy DIR reform in the final Build Back Better Act. The grassroots campaign resulted in nearly 2,400 pharmacists and 3,000 patients from 48 states making over 2,900 connections with Senators urging their support for addressing pharmacy DIR fees in the Build Back Better Act. Additionally, NCPA’s major ad campaign in the Washington, D.C. area continues. You can view NCPA’s ad and other campaign resources here.
NCPA Continues Push for PBM Investigations and Reforms
This week, NCPA CEO Douglas Hoey continued NCPA’s push for greater PBM oversight. In separate letters to Senate Finance Committee Chairman Ron Wyden (D-Ore.) and FTC Chairwoman Lina Khan, Hoey reiterated the need for action on PBMs while also thanking Sen. Wyden for his recent actions in this area. Recently Sen. Wyden urged the FTC to review consolidations in the retail pharmacy market. You can view NCPA’s press release on the letters here.
NCPA Urges Governors to Ensure Patients Receive
Life Saving COVID-19 Oral Therapeutics
This week, NCPA joined pharmacy stakeholders on a letter to the National Governors Association encouraging immediate action be taken to guarantee that pharmacists are paid for patient care services when providing COVID-19 oral antivirals. The recent CMS guidance only encourages, but does not require, Medicare Part D plans to pay dispensing fees to pharmacists for oral COVID-19 antiviral drugs and fails to acknowledge the associated pharmacist clinical services. As a result, there is no Medicare payment pathway for pharmacists or pharmacies for the clinical services associated with dispensing these oral therapies. This is a concern because Medicaid and commercial plans often follow Medicare payment policies. NCPA does not want CMS' new guidance to hinder patients' access to medications that could save their lives.
Engage Your Patients on Fight4Rx
NCPA developed a toolkit of materials that can be utilized in the pharmacy to engage patients and encourage them to take an active role in protecting their right to choose the pharmacy of their choice by participating in Fight4Rx. There are also additional resources you can share with your patients to fight back against PBM steering when they are being encouraged to use a pharmacy other than yours for their medications. Patients are a critical voice and making their voice heard on the need to rein in PBMs is extremely impactful with policymakers. Urge your patients to support Fight4Rx. Contact Michael Rule at mrule@ncpa.org with any questions.
Summary of Part D Rule Changes Effective January 1, 2022
NCPA created a summary of the final Part D rule for contract year 2022 that goes into effect Jan. 1, 2022. Provisions include reporting pharmacy measures and updates for star ratings and electronic prior authorization, both of which mark a step in the right direction. Additionally, the electronic prior authorization requirement – a holdover from earlier rulemaking - starts on January 1, 2022. CMS has started the process for rulemaking in Part D for contract year 2023, and a proposed rule is expected at any time. NCPA will continue to advocate for policies that positively affect community pharmacy as that process moves forward.
NCPA urges Ohio Medicaid to Establish
Transparent Pharmacy Reimbursements
NCPA sent a letter to the Ohio Department of Medicaid urging the Department to establish Medicaid managed care pharmacy reimbursements that are based on the fee-for-service rates, which are NADAC plus a professional dispensing fee. Ohio is moving to a single PBM to administer its pharmacy benefits, and the transparent reimbursement would bolster the state’s efforts to increase accountability in its Medicaid program.
Get Ready for COVID-19 Vaccine Billing Changes Starting
January 1, 2022 for MA and MMP Beneficiaries
Starting January 1, 2022, Medicare Advantage Organizations (MAOs) and Medicare-Medicaid Plans (MMPs) will be required to pay for the COVID-19 vaccine and its administration (including approved booster doses) without cost sharing for beneficiaries enrolled in their plans. MAOs and MMPs are expected to remind their contracted providers of the billing change in advance of January 1, 2022 in order to minimize billing errors. Please be aware of any contractual changes which resulted from these changes.
Compounders, Tell Us What You Think
USP has proposed changes to chapters <795> and <797> as well as tailoring future educational opportunities to those interested in compounding. NCPA plans to submit comments on the changes, and we would like your input. Please complete this survey to share your thoughts.
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 holidays, there will not be an NCPA Advocacy Center Update on December 24 or 31.
The update will resume on January 7.
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.