Only 3 Days Left to Support CMS’ Effort
to Address Pharmacy DIR Fees

Monday is the deadline to submit comments to the docket on CMS’s proposed part D rule, which addresses pharmacy DIR fees. Over the past four weeks, pharmacists submitted nearly 2,500 comments on CMS’ proposed part D rule using NCPA’s comment template. If you have not yet done so, there are only 3 days left to submit your own comment. Template comments should be personalized and submitted through NCPA’s grassroots portal.

Effectively personalize your comments 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)

Additionally, NCPA has created a patient template available through the Fight4Rx platform. Please share this link with your patients and encourage them to take a few moments to submit comments as well.

Support Bipartisan Efforts to Support CMS’ DIR Proposal

Senate and House pharmacy champions are leading bipartisan efforts to voice support for CMS’ proposed action on pharmacy DIR fees. Contact your senators and representative and urge them to sign on to their respective letters. The Senate letter is led by Sens. Jon Tester (D-Mont.), Shelley Moore Capito (R-W.Va.), Sherrod Brown (D-Ohio) and James Lankford (R-Okla.). The House letter is led by Reps. Peter Welch (D-Vt.), Morgan Griffith (R-Va.), Vicente Gonzalez (D-Texas), Buddy Carter (R-Ga.), Raja Krishnamoorthi (D-Ill.), John Rose (R-Tenn.), Abigail Spanberger (D-Va.), and Diana Harshbarger (R-Tenn.). CMS needs to understand that there is broad support in Congress for the agency to finalize pharmacy DIR reform. The deadline for legislators to sign on to their respective letters is FRIDAY (March 4) for the Senate letter and Thursday, March 10, for the House letter.

Sen. Warnock Visits Little Five Points Pharmacy

Ira Katz, owner of the Little Five Points Pharmacy in Atlanta hosted a discussion of the Affordable Insulin Now Act with Sen. Raphael Warnock (D-Ga.), a co-sponsor of the legislation, and Bob Coleman, CEO of the Georgia Pharmacy Association; Jonathan Marquess, president and CEO of the Institute for Wellness and Education; and Blaire Carter, clinical pharmacist at Little Five Points. Affordable Insulin Now would cap the out-of-pocket cost of insulin for patients and would require Medicare plans and private group or individual plans to cap patients’ out-of-pocket costs for insulin at $35 per month.

NCPA One-Pager Shows PBM Reform Does not Raise Costs

A new NCPA resource confirms that controlling PBM conflicts of interest does not raise costs for patients or payers. The one-pager compares changes in health insurance premiums in states that enacted PBM reform to the average changes in health insurance premiums nationwide. Not only did the states with PBM reform see lower increases in premiums than the national average, some states actually saw their premiums decrease. This is important information for lawmakers to know as they consider policies that protect patients and pharmacies from abusive PBM practices, but are bombarded with misinformation about potential raises in costs if those protections are put in place.

Share Your Oral Antiviral Medication Activity with NCPA

NCPA needs your stories of how you are ensuring safe and effective use of the new oral antiviral medications to help us make your case for adequate reimbursement with the government. Report your involvement with the COVID oral antiviral treatments and any changes in your status with these products over the coming months. You can access the tool here.

Provider Relief Fund Updates

For those participating in the provider relief fund, HHS has updated their FAQ to answer your questions about tax information (Form 1099) and overpaid returned payments. A few key points:

• Form 1099s will be available and mailed by January 31st, but if you have previously established an account with UnitedHealthGroup and elected to receive electronic copies, you will not receive a mailed copy.
• If a provider returns payment to the Provider Relief Fund and the return amount is greater than what should be returned to the Government, HRSA will generally refund the provider the erroneously returned amount.

Florida PBM Bill Passes Legislature

Florida HB 357, which strengthens existing pharmacy audit protections and state enforcement authority over PBMs, has passed both the House and Senate. The bill is headed to Gov. Ron DeSantis’s (R) desk for his signature.

Oklahoma PBM Bills Reported out of Committee

Two PBM bills in Oklahoma have been reported out of committee. HB 3924 would amend existing patient pharmacy choice laws, prohibit spread pricing, and give the Insurance Commissioner increased enforcement authority over PBMs. SB 1085 would fund the Insurance Commissioner’s efforts to regulate PBMs.

Wyoming PBM Bill Passes First Chamber

The Wyoming Senate passed SF 36. The bill contains provisions to address many PBM abuses, such as adjudication fees, retroactive claims adjustments, and pharmacy audits.

NCPA, NASPA, APhA support Provider Status
and Payment for Services in Maryland

NCPA joined with NASPA and APhA to provided written testimony to the Maryland House Health & Government Operations Committee in support of House Bill 1219 which recognizes pharmacists as health care providers and authorizing reimbursement parity for their services. This bill also mandates insurance coverage for services within a pharmacist’s scope of practice and if the services are offered by another license provider. There are significant cost savings and improved health outcomes associated with pharmacists receiving optimal payment rates. We are happy to stand with the Maryland Pharmacists Association in support of this bill that ensures more patients to have greater access to care while supporting the sustainability of local pharmacies in the community.

NCPA Advocates for Action to Ensure
Workplace and Patient Safety

NCPA submitted a letter of support to the Virginia Senate Committee on Education and Health in support of House Bill 1323 which directs the state Board of Pharmacy to adopt regulations related to workplace safety that protects the health and safety of patients. Increased workload and reports of burnout, even before the COVID-19 pandemic, have been associated with medication and dispensing errors. NCPA has submitted two letters to the Virginia Board of Pharmacy concerning work environment requirements within pharmacies and its impact on care and patient safety.

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.