NCPA Advocacy Update

Week ending March 11

Author: APCI Staff/Monday, March 14, 2022/Categories: Legislative Affairs

NCPA Highlights Changes Required
to Make DIR Proposal Workable

This week, NCPA submitted comments to CMS on the proposed DIR Rule which included several recommendations required to make the rule workable. Among its recommendations, NCPA noted that CMS must close the coverage gap loophole, ensure transparency of pharmacy reimbursements at point of sale, and address the effects of the rule on pharmacy cash flow. These recommendations were echoed by more than 2,700 pharmacists who submitted comments through NCPA’s grassroots portal. Additionally, more than 230 organizations and 30 U.S. Senators submitted letters supporting CMS’ intent while calling for necessary changes to make the rule workable. See NCPA’s news release on our comments here.


Small Business Administration Submits Comments
on Behalf of Pharmacy on CMS Part D Rule

This week, the Small Business Administration (SBA) submitted a comment letter to CMS on the Medicare Part D proposed rule for Contract Year 2023. The SBA submitted these comments on behalf of small business pharmacies and relied on data provided by NCPA. In the letter, the agency highlights several issues NCPA raised in our own letter regarding the potential policy changes, including clarification on claw-backs, a more complete definition to capture PBM fees, a standardized set of performance measures, and potential ways to address cash-flow issues should the rule be implemented. NCPA welcomes SBA recognizing the issues with the rule as proposed and weighing in with another executive agency on behalf of our membership. NCPA will continue to work with CMS through the regulatory process.


House Champions Extend HHS DIR Letter Sign-on Deadline

House pharmacy champions 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.) have extended the deadline to March 15 for members of the House to sign-on to the letter to HHS Sec. Xavier Becerra on CMS’ DIR Proposal. If you have not yet done so, please contact your representative and urge them to sign-on to this bipartisan effort.


NCPA Joins Pharmacy Organization Letter on Test and Treat

This week, NCPA joined thirteen other national pharmacy organizations on a letter to President Biden (D) regarding his “test and treat” announcement. The organizations applauded the President for recognizing the opportunity pharmacies present in expanding access to oral antivirals but highlighted that only a few pharmacy locations are currently eligible. The pharmacy organizations called on the FDA to modify its EUA and remove the limitations on pharmacists from ordering these medications.

Additionally, both NCPA CEO Doug Hoey and President Michele Belcher, owner of Grants Pass Pharmacy in Grants Pass, Ore. were quoted in a Medpage Today article noting that the current test and treat order is limiting and leaves out patients in underserved communities that may not have access to a primary care physician.


NCPA Notes Independent Pharmacies Pushed Out of Tricare

This week, Karry La Violette, NCPA Senior Vice President of Government Affairs, spoke with Stars and Stripes about pharmacy Tricare contracts and independent pharmacy’s inability to participate in the program. La Violette noted that the contracts offered by Express Scripts are take it or leave it with terms that often leave independent pharmacies dispensing at a loss. La Violette also highlighted that at the same time, Express Scripts’ own mail order pharmacy is sending unwanted prescriptions to beneficiaries and creating significant waste.


Senate Finance Committee to Hold Drug Pricing Hearing

This week, Senate Finance Committee Chairman Ron Wyden (D-Ore.) announced that committee will hold a hearing on Wednesday March 16 titled, “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare.” NCPA will provide updates on any developments from the hearing.


Senator Grassley Urges the FTC to Move Ahead with PBM Study

This week, Senator Charles Grassley (R-Iowa) sent a letter to FTC Chairwoman Lina Khan urging the FTC to move ahead with a 6(b) study on PBMs. In the letter Grassley noted, “Looking at the record from the FTC’s open hearing on February 17, there is widespread support amongst all of the Commissioners to conduct a 6(b) study into the business practices of PBMs. A more targeted focus for the study on the impact of PBMs on consumers and the out-of-pocket costs of their prescription drugs appears to be an area of agreement. I encourage you to come together with your fellow commissioners to find common ground on a meaningful 6(b) study.” 

We appreciate Senator Grassley’s continued support for patients, pharmacies and lowering the cost of drugs.


Kentucky House Passes PBM Reform Legislation

HB 457, introduced by Reps. Sheldon and Bentley, passed the House Committee on Health and Family Services and is headed to the House floor. This bill provides comprehensive PBM reforms to protect patient choice and pharmacy access in Kentucky. NCPA is proud to support this legislation.

Some of the reforms in HB 457 include:

  • Prohibition on coercive copays intended to steer patients
  • Prohibition on mandatory mail order
  • Prohibition on reimbursing non-affiliate pharmacies less than PBM affiliated pharmacies
  • Prohibition on retroactive claims adjustments and fees
  • Prohibition on PBMs requiring more stringent accreditation requirements than state law
  • Requires PBM reporting
  • Sets limitations on drugs that can be designated as “specialty drugs”
  • Creates a fiduciary duty owed by a PSAO to a pharmacy or pharmacist

NCPA, OPA Urge Transparency in New Ohio PBM Model

NCPA and the Ohio Pharmacists Association sent a letter to Gov. Mike DeWine (R) applauding efforts to reform Ohio’s Medicaid managed care pharmacy benefit and urging “the department to bolster these measures by establishing transparent and competitive pharmacy reimbursement benchmarks in the Medicaid managed care program. Specifically, the department should consider requiring the MMC PBM to base pharmacy reimbursements on a transparent acquisition cost-based model, much like the Medicaid fee-for-service program, which includes a prescription ingredient cost equal to the National Average Drug Acquisition Cost plus a professional dispensing fee.” Ohio Medicaid managed care recently adopted a single PBM, Gainwell Technologies, to administer the pharmacy benefit. The letter underscores the importance of adopting a transparent benchmark such as a NADAC or AAC and an adequate professional dispensing fee The new single PBM model will be implemented on July 1, 2022.


West Virginia Patient Choice Bill Reported out of Committee

The West Virginia Senate Committee on Health and Human Resources favorably reported HB 4112. The bill would prohibit PBMs from implementing arbitrary pharmacy accreditation requirements and specialty drug criteria.


Hawaii Senate Passes PBM Legislation

The Hawaii Senate passed SB 2443, which gives the Insurance Commissioner greater authority to enforce new and existing provisions protecting patients and pharmacies from PBM abuses.


NCPA Joins the Minnesota Pharmacy Groups
to Support HIV PrEP/PEP Pharmacists’ Authority

NCPA submitted written testimony to the Minnesota House Health Policy and Finance Committee in support of HF 3854 which would authorize pharmacists to prescribe and dispense “preexposure prophylaxis” (PrEP) and “postexposure prophylaxis” (PEP) to treat human immunodeficiency virus (HIV). The bill authorizes pharmacists to order, conduct and interpret laboratory tests related to PrEP & PEP and provides mandatory coverage for these services. The legislation safely expands HIV prevention and treatment access to patients, and we thank the Minnesota Pharmacists Association and Minnesota Retailers Association for the opportunity to support this important legislation.


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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