NCPA Part D Rule Comment Template

NCPA has created a comment template for comment on CMS’ proposed Part D rule, that includes language addressing pharmacy DIR fees. Template comments should be personalized and submitted through NCPA’s grassroots portal. Please share this link (https://p2a.co/Pb86xUt) with your stakeholders and strongly encourage them to personalize the template prior to submission to make their comment more impactful.

The template can be effectively personalized by:

• Adding background on pharmacy including personal anecdotes about how long your pharmacy has been serving Part D patients and what percentage of reimbursement Part D represents
• Discussing the harm that will come to their patients, pharmacy, and employees if pharmacy DIR fees are not addressed (examples: have reduced pharmacy hours, stopped providing free home delivery of medications to seniors, closed your pharmacy)
• Providing examples of how pharmacy DIR fees have increased and how they have impacted their business (examples: reduce staff, reduce charitable/community donations)

NCPA Launches New Ad Targeting PBMs

This week, NCPA launched a new TV ad running in multiple states and the District of Columbia as part of a coordinated effort with state pharmacy associations. The ad urges seniors and other pharmacy customers to tell their senators to stop health insurance plan-owned-PBMs from charging discriminatory and unfair fees that put local pharmacies out of business and limit patient access to prescription medications and the pharmacy of their choice.

NCPA Reiterates Antitrust Concerns to FTC/DOJ
Over UnitedHealth-Change Healthcare Deal

This week, NCPA CEO B. Douglas Hoey reiterated his call to Federal Trade Commission Chair Lina Khan and Jonathan Kanter, assistant attorney general for the Department of Justice’s Antitrust Division, for the federal government to block UnitedHealth Group’s acquisition of data giant Change Healthcare.

UHG owns United Healthcare, a major health insurer, and Optum, a pharmacy benefit manager and mail order pharmacy. Change Healthcare is a massive technology company through which sensitive pharmacy data runs straight to pharmacy benefit managers. Hoey has been warning for months that this merger would create a massively unfair advantage in the marketplace for a company that is already dominant, and is a threat to fair competition, independent pharmacies, and patient choice.

CMS Releases Advanced Notice for CY 2023
for MA/Part D Plans

This week, CMS released the Calendar Year (CY) 2023 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, which focuses on payment for MA plan beneficiaries as well as requests for information related to better capturing data on social determinants of health and quality measures for Star Ratings for Part D. CMS is accepting comments on the proposed changes until March 4, 2022 and will release the updated capitation rates by April 4, 2022. NCPA will be providing feedback on the CMS proposal to adopt changes of the PQA metrics into the Star Ratings for CY2023.

HRSA Announces $12 Reimbursement Rate
for Dispensing OAVs

The Health Resources & Services Administration announced a dispensing fee of $12 in the COVID-19 Uninsured Program for oral antiviral drugs, or OAVs. Pharmacies that are dispensing oral antiviral drugs to uninsured patients will use the same process through OptumPay to attest they attempted to locate coverage information and obtain a temporary member ID. Refer to specific instructions from your medical billing intermediary on what data is needed in the prescription claim. NCPA is still in constant contact with the Biden-Harris Administration regarding the dismal rates. Click here for general information on billing for OAV dispensing fees.

NCPA Provides Comments to IFC on Reporting
on Pharmacy Benefits and Prescription Drug Costs

Last week, NCPA provided comments to HHS and three other agencies with jurisdiction over various health plans, on the reporting of data for expenditures for prescriptions and other costs. However, this rule does not pertain to Medicare Part D. The rule became effective December 27, 2021, but the agencies are deferring enforcement for the first year. The comments focused on the inclusion of pharmacy DIR as part of the reporting requirement on drug concessions and increasing transparency on PBM activities. NCPA had previously provided comments and will continue to advocate for greater PBM transparency in all available avenues.

HHS Determines that $1.8 billion in COVID-19
Testing Contracts Were Properly Managed

HHS Assistant Secretary for Administration (ASA) awarded five COVID-19 testing contracts totaling $1.8 billion to national pharmacy and grocery retail chains. HHS OIG, an independent investigatory office, audited HHS ASA and found that the contracts were managed correctly, because HHS ASA established and maintained ongoing communications with contractors, by verifying that lab result numbers matched the number of tests administered, and by reviewing invoices to ensure payment rates were in accordance with the contract terms and conditions. Click here to learn more about the audit.

340B Hospitals Report Significant Losses
Following Restrictions

As the number of pharmaceutical manufacturers with restrictions on 340B deliveries has increased to 13, a recent survey has revealed covered entities have lost a significant portion of the 340B savings they receive through the contract pharmacy model. A survey of 510 entities shows that large, urban facilities have reported an average of 23% loss (average: $1 million) of the savings -a tenth of the hospitals reported losses of $9 million or more, while critical access hospitals reported a 39% (average: $220,000) drop, however a tenth of those facilities lost $700,000 or more. At the time of the survey, there were only eight manufacturers with restrictions, so these losses might be underrepresented. Currently, there is ongoing litigation over the ability of HRSA to manage the program and force manufacturers to deliver drugs to contract pharmacies.

NCPA Supports Hawaii PBM Bill

This week, NCPA submitted a letter of support for HB 1783, which would give the insurance commissioner stronger enforcement authority over PBMs. The bill was heard by the House Committee on Health, Human Services, & Homelessness, which decided to defer the bill.

NCPA Provides Testimony for Administration
of Long Acting Injectables

NCPA provided written comments and spoke before the Maryland House of Delegates’ Health & Government Operations Committee in support of HB229. This bill expands the definition of “maintenance injectable medication” to include sexually transmitted infections and to allow those medications to be administered by a pharmacist. State Government Affairs Manager Belawoe Akwakoku stated that the legislation will expand access to thousands of Marylanders who would otherwise forgo treatment.

NCPA, NASPA, and APhA Submit Testimony
for Vaccine Authorities in Nebraska

NCPA, the National Association of State Pharmacy Associations (NASPA) and the American Pharmacists Association (APhA) sent a joint letter to the Nebraska Legislature’s Health Human Services Committee in support of LB812, which would authorize pharmacy technicians to administer vaccines under a pharmacist’s supervision. This bill will keep these new authorities in place as the permissions granted under the PREP Act expire in 2024.

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.