Pay Close Attention to Upcoming Part D Contract Terms
NCPA is advising members that some PBMs may offer reduced reimbursement for the upcoming Medicare Part D plan year (CY2023). NCPA anticipates that the terms some PBMs may offer might reimburse independent pharmacies below their product acquisition cost. Additionally, please be aware that some contracts are opt-out contracts that require a pharmacy to proactively send a specific form of notice to a PBM, sometimes within a short period of time, declining participation in the network if the pharmacy determines that the terms offered are not satisfactory. Otherwise, the PBM-proposed terms would likely go into effect for the entire 2023 Medicare Part D plan year. Part D plans and PBMs are required by law to maintain network access standards for beneficiaries. Further, PBMs are required to have “reasonable and relevant terms and conditions” for any willing pharmacy (more background here) to participate in a Part D network, so pharmacies should review any proposed contract for issues which might adversely affect their operation. Members should make an independent business decision as to whether the proposed terms are appropriate for their pharmacy. NCPA urges member pharmacies to carefully evaluate the financial and other terms of any proposed contract and to adhere to PBM deadlines and any specific notice requirements in their contract with a PBM.
NCPA Supports Federal Legislation Introduced
to Expand Access to Pharmacists Services
Reps. Ron Kind (D-Wis.), David B. McKinley (R-W.Va.), Nanette Diaz Barragán (D-Calif.), and Buddy Carter (R-Ga.) introduced the bipartisan H.R. 7213, Equitable Community Access to Pharmacist Services Act. This legislation will help ensure patients can continue to access COVID-19 pandemic and pandemic-related health services from pharmacists and provide payments for these services. It would provide coverage for pharmacist services under Medicare Part B for COVID and flu vaccines; COVID, flu, strep and RSV testing; and COVID, flu and strep treatment. NCPA is proud to support this important bill. The legislation can be found here.
HHS Announces $413M in PRF Funds and Continuing Review
of Remaining Applications
This week, HHS announced another round of Provider Relief Funds, which providers will have until the end of June 2023 to use. Additionally with the latest round of payments, HHS said any applications still requiring to be processed need manual review and will be completed as soon as possible. This latest round of funding brings the total for Phase 4 of the PRF to $12B, which has been distributed to approximately in 82,000 providers. If you have applied for Phase 4 funding and have not received funds, please check the HRSA website here: Current and Future Payments.
Senator Braun Asks Administration to Remove Red Tape
from Oral Antiviral Program
Last week, Senator Mike Braun (R-Ind.) asked the Biden Administration to remove federal bureaucracy as to maximize access to life saving COVID oral antivirals. He emphasized that the setting of dispensing fees for oral antivirals is being left “to controversial middlemen in the insurance industry known as pharmacy benefit managers.” The letter cites concerns both about the dispensing fees and the ability, or lack thereof, for pharmacist to prescribe oral antivirals, thus losing the opportunity to maximize the effectiveness and accessibility of the oral antivirals.
NCPA Urges New York Governor to Support
Medicaid Pharmacy Reimbursement Reform
In a letter to Governor Hochul (D), NCPA asked that she honor her commitment to address Medicaid Managed Care (MMC) pharmacy reimbursement reform in the budget process. Late last year, the Governor vetoed (S.6603_Skoufis/A.7598_Gottfried) with overwhelming support from both the Senate and Assembly which would have required Medicaid managed care to reimburse pharmacies at the same rate as Medicaid fee for service. Governor Hochul’s reasoning was that Medicaid pharmacy reimbursement reform should be addressed in the budget process. Unfortunately, she has yet to include this important language in the executive budget. The Pharmacists Society of the State of New York (PSSNY) and other state advocacy groups have done a fantastic job bringing attention to this issue, including holding a rally attended by more than 100 pharmacists outside the Gov’s Manhattan office on March 18. Thank you!
NCPA, APhA and NASPA support Tobacco Cessation and
Contraception Prescribing Authority in Rhode Island
NCPA, APhA and NASPA signed joint letters to support S 2329 and S 2330 as testimony presented to the Rhode Island Senate Committee on Health and Human Services. S 2329 authorizes pharmacists to prescribe and dispense tobacco cessation medications and S 2330 permits pharmacists to prescribe and administer all FDA-approved hormonal contraceptives. Both pieces of legislation include mandatory coverage from state Medicaid programs and commercial insurers.
NCPA Supports HIV PrEP/PEP Administration in Illinois
NCPA submitted written testimony in support of HB 4430, which would allow pharmacists to administer “preexposure prophylaxis” (PrEP) and “postexposure prophylaxis” (PEP) to treat human immunodeficiency virus (HIV). This legislation includes mandatory coverage and compels payers to reimburse pharmacists no less than 85% the rate of other providers who provide the same service.
Iowa PBM Reform Bill Passes the House
Iowa HF 2348 has passed the House. The PBM reform bill contains protections from intrusions on patient choice, network participation, retroactive claim adjustments, opaque reimbursement methodologies, and other PBM abuses. The bill is now being considered by the Senate.
Kansas House Passes Pair of Pro-Pharmacy, Pro-Patient Bills
The Kansas House passed House Substitute for SB 28. This legislation requires PBMs to be licensed rather than registered in the state, thus giving more regulatory oversight of PBMs to the Kansas Department of Insurance. It increases both the fee and penalties for PBMs, as well as creates a MAC appeals process. The House also passed SB 200 which authorizes a pharmacist to initiate therapy within the framework of a statewide protocol for the flu, strep, or urinary tract infections. The Senate must now consider amendments to each bill made by the House.
Kentucky PBM Reform Bill Passes the House
Kentucky HB 457 passed the House. The bill, introduced by Reps. Steve Sheldon (R-District 17) and Danny Bentley (R-District 98), both pharmacists, provides comprehensive PBM reforms to protect patient choice and pharmacy access in Kentucky. The bill is now being considered by the Senate.
Missouri PBM Reform Bill Passes the House
Missouri HB 1677 has passed the House. The PBM reform bill addresses patient choice, PBM-affiliated pharmacy reimbursements, under-water reimbursements, and other PBM abuses. The bill is now being considered by the Senate.
Oklahoma Patient Choice Bill Passes Senate
Oklahoma SB 1860 passed the Senate. The patient choice bill strengthens existing patient protections by protecting a patient’s ability to choose the in-network provider of his or her choice. The bill is now being considered by the House.
Vermont PBM Reform Bill Passes the House
Vermont HB 353 passed the House. The PBM reform bill protects patient choice, strengthens existing MAC appeals language, adds pharmacy audit protections, and addresses PBM conflicts of interest. The bill is now being considered by the Senate.
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.