Need to Address Pharmacy DIR Fees Highlighted
at Senate Finance Committee Hearing

This week, the Senate Finance Committee held a hearing titled, “The President’s Fiscal Year 2023 Health and Human Services Budget,” to hear from Secretary Xavier Becerra on the President’s FY 2023 budget request. Committee Members discussed areas of bipartisan interest, including mental health, medication-assisted treatment for substance abuse, rural health access, and extension of telehealth services. Senator James Lankford (R-Okla.) thanked Secretary Becerra for CMS’s proposed rule to address pharmacy DIR fees and urged him to finalize the rule without letting special interest’s water down what needs to be done for rural pharmacies. Chairman Ron Wyden (D-Ore.) also praised the CMS proposed rule and described the PBM practice to recoup retroactive fees from pharmacies as a “rip off” that harms small pharmacies and consumers in underserved areas.

Another Member of Congress Voices Support
to HHS for DIR Reform

This week, Rep. Mikie Sherrill (D-NJ) sent a letter to HHS Secretary Xavier Beccera in support of CMS’s proposed rule that reforms pharmacy DIR fees. Her letter echoes the letters previously sent by 85 House members and 30 Senators urging for the rule to be finalized with the edits NCPA has been advocating for with its pharmacy partners.

Oklahoma Court Decision Another Win
for Independent Pharmacy on ERISA Preemption

This week, the U.S. District Court for the Western District of Oklahoma in PCMA v. Mulready put another win in the independent pharmacy and patient column on the question of ERISA preemption. The court found that ERISA preempted none of the challenged provisions of Oklahoma’s Patient’s Right to Pharmacy Choice Act, thus reinforcing the state’s broad authority when it comes to regulating PBM practices in Oklahoma. The court also followed a similar line of reasoning as we saw in PCMA v. Wehbi on questions of Part D preemption. The court found that several provisions within the statute were not preempted by Medicare Part D, therefore, Oklahoma has the authority to regulate in these areas as well. PCMA will have an opportunity to file a motion for reconsideration in the Western District of Oklahoma or appeal the matter to the 10th Circuit Court of Appeals.

NCPA Meets with Officials to Discuss Concerns
with Part D CY2023 Proposed Rule

NCPA has met with Senate Finance Committee leadership, CMS leadership and will be meeting with officials from the Office of Management and Budget (OMB) soon to discuss CMS’ proposed CY2023 Part D rule that would end retroactive DIR fees. A final rule is now in clearance at OMB, its last stop before being made public. NCPA continues to seek positive changes to the rule and is asking CMS to resolve or clarify the following:

• Pharmacy reimbursement must be transparent at POS and linkages need to be mandated that require the lowest possible reimbursement equals the amount paid on the pharmacy remittance advice within prompt pay rules of 14 calendar days.
• All pharmacy price concessions must be attributable at the claim level even if not computed or assessed at time of dispensing Part D drug.
• Close the coverage gap loophole which allows PBMs to continue DIR games and will cause confusion at pharmacy counter.
• Address rule’s impact on pharmacy cash flow by requiring PBMs to offer payment plans to pharmacies for a reasonable period to collect CY2022 DIR fees in CY2023.
• CMS needs to conduct a small business impact analysis regarding the rule’s financial impact on small business pharmacy.

CDC Offers Guidance to Pharmacies
on COVID Administrative Procedures

Due to the lack of supplemental funding from Congress, the Health Resources and Services Administration stopped accepting claims for reimbursement of costs associated with administering COVID-19 vaccines to uninsured and underinsured individuals as of 11:59 p.m. ET on April 5, 2022. The Centers for Disease Control and Prevention strongly encourages providers to stay in the CDC COVID-19 Vaccination Program, and CDC expects participating providers will continue to administer these lifesaving vaccines at no cost to patients to ensure equitable access for all individuals. NCPA is emphasizing the difficulty pharmacies will have in providing these vaccines without the administration fee and will provide more details as they become available.

MedPAC Meets, Begins Discussion
on Role of Rebates in Part D

This week, the Medicare Payment Advisory Commission (MedPAC) held their monthly meeting. Staff presented their initial findings after being granted unique access to direct and indirect renumeration (DIR) data by Congress in the Consolidated Appropriations Act. Staff confirmed the data being reported by the PBMs to CMS is accurate. The discussion and questioning by the Commissioners focused on the impact of manufacturer rebates on drug prices and the inability of plans to negotiate for rebates on specialty drugs due to lack of competition. Additionally, the Commissioners mentioned issues with formulary placement and potential impacts on DIR despite the staff noting that the fastest growing DIR is pharmacy concessions. As noted by the Chair during the meeting, this study is the beginning of the process and needs to be refined. NCPA will monitor the discussion of MedPAC as it moves through the study and report process.

Join NCPA PAC for a Virtual Meet and Greet on April 13th

Join the NCPA PAC for a Virtual Meet and Greet with fellow NCPA Member Chris Schiller. Chris, a former President of the Oklahoma Pharmacists Association, and current owner of Economy Pharmacy is running for the open 2nd Congressional District seat in Oklahoma. Chris will be joined by special guest Rep. Buddy Carter (R-GA). The Meet and Greet will be held on Wednesday, April 13th at 8 PM Eastern. To sign up for the event, visit this link. For more information on the event, or questions, please contact Eric Nielsen at 703-600-1182 or pac@ncpa.org. To find out more about Chris’s candidacy please click here.

CMS Begins to Wind Down PHE Waivers

This week, CMS announced new guidance to end certain emergency declaration waivers for skilled nursing facilities, hospices, and other facilities. Within 30 days, CMS will restore requirements for in person residence groups and certain physician tasks and authorities. Within 60 days, CMS will restore requirements for in-service training for LTC facilities, training requirements for nurse aids, and certain waivers regarding the physical space for the caring of patients. NCPA will continue to be vigilant for the restoration of any waivers which directly impact LTC pharmacies and to advocate for extensions of flexibilities which allow pharmacists to assist patients. Join NCPA’s LTC Divisionto stay up to date on the latest developments and to be engaged in the efforts for LTC.

Provider Relief Fund to Reopen Reporting
Due to Extenuating Circumstances

HRSA is reopening the reporting window for Provider Relief Fund recipients to submit reporting for Period 1 if extenuating circumstances apply. If you received a PRF payment between April 10, 2020 and June 30, 2020 this may apply to you. The window will reopen from Monday, April 11, to Friday, April 22, 2022 at 11:59 p.m. ET. You can apply here for the extended reporting window via a Docusign form if any of the extenuating circumstances apply. More instructions can be found on the PRF Reporting Webpage. Note: this is NOT for the HRSA Uninsured Program.

Share Your Examples of PBM Harms with the FTC

The FTC is seeking examples of patient and consumer harm caused by PBMs. Please take a few moments and share your examples of patient harms with the FTC, using this template as a guide. It is important that you personalize this with your own examples and let the FTC know how your patients will continue to be harmed if PBMs are not addressed and be sure to remove anything from the template that may not pertain to you. Once your comment is ready, you can submit it here. Comments are due by April 25.

Invite Your Legislator for a Visit
During the Congressional Recess

Congress is currently scheduled to be in recess through April 25. This is an ideal time to invite your member of Congress to tour your pharmacy and give them a first-hand look at the crucial role you play in your community’s health care system, build relationships, and promote pro-pharmacy and pro-patient legislation. Click here for tips on scheduling a pharmacy visit or contact Michael Rule at mrule@ncpa.org for assistance. The next scheduled recess is May 27 - June 6.

NCPA Attends NAIC PBM Discussion

NCPA’s Matt Magner attended the National Association of Insurance Commissioners’ Spring Meeting in Kansas City. Magner attended the PBM Issues Subgroup meeting, which included presentations from insurance department staff from Oklahoma and Oregon, as well as a presentation from patient groups regarding the impact of PBM practices and regulations on patients. NCPA also had the opportunity to talk with NAIC members about the importance of PBM reform for patients and pharmacies.

Stakeholders Author Letter to FDA on the NASEM Report

This week, NCPA joined the Alliance for Pharmacy Compounding, American Pharmacists Association, and PCCA on a letter to FDA Commissioner Robert Califf to highlight recent evidence in a peer-reviewed study on compounded bioidentical hormone therapy (cBHT). The evidence published in the report contradicts some of the negative conclusions drawn by the NASEM report on the topic. The letter requests the agency to consider the new information as the FDA moves forward to respond to the report. NCPA will continue to advocate for the patient access for cBHT to be maintained.

NCPA Supports Legislation for Enhanced Reimbursement
for Pharmacists in Louisiana

NCPA submitted a letter of support for SB82 to the Louisiana Senate Committee on Health and Welfare to advocate for enhanced reimbursement for pharmacy services. Senate Bill 82 would require the Louisiana Department of Health to submit a State Plan Amendment to the Centers of Medicare and Medicaid to enhance reimbursement for services within a pharmacist’s scope of practice.

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.