NCPA Advocacy Update

Week ending January 7

Author: APCI Staff/Monday, January 10, 2022/Categories: Legislative Affairs

CMS Releases MA/Part D Proposed Rule
for Contract Year 2023

On January 6, 2022, CMS released the text of the proposed rule for the upcoming contract year. In the proposal, CMS attempts to address pharmacy price concessions which grew 107,400% over a ten year period by moving pharmacy price concessions to the point of sale. CMS estimates requiring pharmacy price concessions in the negotiated price is expected to reduce beneficiary costs by $21.3 billion over 10 years, or approximately 2 percent. NCPA has created a member summary of the rule and will also be submitting comments by the due date of March 7, 2022.


Sen. Brown Highlights Effort to Secure CMS Commitment
to Address Pharmacy DIR

On Wednesday, January 5, Senator Sherrod Brown (D-Ohio) hosted a news conference call to discuss his work securing a commitment from Chiquita Brooks-LaSure, Administrator of CMS, to make it easier for community pharmacies to lower drug prices for Ohioans by addressing pharmacy DIR fees. Additionally, he issued a press release, which features a quote from NCPA.


HHS Releases 10th Amendment to the PREP Act,
Assists Pharmacists

On December 30, 2021, HHS released the 10th Amendment to the PREP Act. Earlier Amendments to the PREP Act expanded the scope of pharmacists and pharmacy interns to administer vaccines, including the flu vaccine. Now, the Administration is permitting licensed pharmacists and pharmacy interns to administer seasonal flu vaccines in jurisdictions outside where the pharmacist or intern is licensed in order to respond to where increased need is the greatest. By granting this flexibility and protection under the PREP Act, HHS seeks to minimize the impacts of both COVID-19 and the flu. NCPA will continue to advocate for opportunities to practice at the top of their license to serve their communities and patients.


Changes to Medicare COVID-19 Vaccine Billing

Pharmacies administering COVID-19 vaccine boosters or primary series doses to Medicare patients should be aware of a significant change to the billing process. Patients who have a standalone prescription drug plan will still be paid by Part B fee-for-service. All other Medicare patients (e.g., Medicare Advantage plans, MAPDs) will be covered by the managed care plan which may cover the administration fee on the pharmacy benefit, medical benefit, or both. CMS allows these managed care plans to deny payment to out-of-network providers unless the plan has an out-of-network benefit. For information on determining the plan type or on submitting denied claims to the Coverage Assistance Fund (NOT the HRSA Uninsured Program), read the updates to NCPA’s COVID-19 vaccine billing handout.


Congressman Jerry Carl Visits Alabama Community Pharmacy

NCPA member Danny Cottrell and his staff hosted a pharmacy visit with Congressman Jerry Carl (R-Ala.) at Semmes Pharmacy in Semmes, Alabama. Cottrell shared information on ever increasing pharmacy DIR fees and that Semmes Pharmacy has given over 14,000 COVID vaccines. Additionally, Congressman Carl received a flu shot while visiting the pharmacy.


NY PBM Reform Legislation Signed into Law

After an end-of-the-year advocacy push by independent pharmacy advocates including NCPA and PSSNY, New York Gov. Kathy Hochul (D) signed into law two of the three bills in the state legislature’s Pharmacy Rescue Package. The bills had been on Hochul’s desk for months after the package was passed by an overwhelming majority of the state legislature in June. Hochul signed:

  • S. 3762/A. 1396, requires PBMs to register and be licensed in the state; requires PBMs to pass through all discounts, rebates, and price concessions to health plans or providers; and prohibits PBMs from requiring accreditation requirements than are more stringent than state or federal laws.
  • S. 3566/A. 5854A, bans mandatory mail order and protects patients’ ability to use the pharmacy of their choice.

NCPA, which ran a digital campaign supporting the bills, is disappointed that Hochul chose to veto the third bill, S.6603/A.7598, which would have required Medicaid managed care plans to reimburse pharmacies at a transparent rate that more closely reflects the pharmacies’ acquisition costs plus a commensurate professional dispensing fee. NCPA and independent pharmacy advocates in New York will continue to fight for this bill.


Stakeholders Ask USP to Extend Comment Period

Last month, NCPA joined the Alliance for Pharmacy Compounding and the American Pharmacists Association on a letter to USP. The letter asks USP for an extension of the comment period for changes to Chapters <795> and <797> for an additional 3 months in order to assess the impact of the rule in practitioners and gather feedback to inform comments.


PQA Endorses Two Pharmacy Measures

On December 20, 2021, PQA endorsed the adoption of two new pharmacy measures. PQA authored the Proportion of Days Covered Composite (Pharmacy) (PDC-CMP-PH) which evaluates adherence to diabetes medications, renin angiotensin system antagonists, and statins for health conditions that are major drivers of serious illness, disability, death and health care costs. Additionally, PQA created the Specialty Pharmacy Turnaround Time (SP-TAT-PH) measure which evaluates the turnaround time of specialty pharmacy prescriptions to help patients receive medication when they need it as a response to stakeholder requests. NCPA submitted comments to assist PQA in their mission to better assess pharmacy performance for use in accountability programs.


NCPA and APC Announce Briefing for Prescribers
on upcoming BUD Changes

In response to proposed changes by the USP to beyond use dates for compounded medications, NCPA and APC are hosting a briefing focused on prescribers to explain the changes and the impact on patient care. NCPA is requesting all compounding pharmacies to share the following registration link with their prescribers: http://A4PC.org/budbriefing. The 30 minute briefing will take place on Thursday, January 20, 2022 at 5PM EST.


CMS Rescinds CMMI “Most Favored Nation” Program

On December 27, 2021, CMS issued a final rule to rescind the Part B “Most Favored Nation” model. The model, which would have been a seven year demonstration, would have capped CMS spending for high cost Part B drugs and biologicals at the “lowest prices that drug manufacturers received in similar countries.” CMS made the decision to withdraw the rule based on the nationwide injunction, potential additional litigation, and concerns expressed by stakeholders with the model. The agency will continue to explore other ways to reduce the costs of Part B drugs for patients. The withdrawal is a victory for NCPA as we submitted comments expressing our concerns on implementation of the MFN model and urging rescission.


NCPA State Legislative Activity Update

NCPA tracks state legislation related to our top three state priorities: Medicaid reformscope 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.

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