CMS Released the Final Medicare Part D Rule;
Good and Bad, More to Come
The Biden administration has released the final Medicare Part D rule. Good news is that pharmacy DIR fee reform will be implemented; bad news is it's delayed for another year. We are continuing to review all details. Follow us on Facebook and Twitter to get updates as we have them.
Sec. Becerra Questioned on Proposed DIR Fix
During Congressional Hearing
This week, the House Energy and Commerce Health Subcommittee held a hearing featuring testimony from HHS Secretary Xavier Becerra on the agency’s proposed budget request for fiscal year 2023. Reps. Peter Welch (D-Vt.) and Buddy Carter (R-Ga.) asked Becerra about the proposed CMS rule to end retroactive pharmacy DIR fees and stressed the need to implement the rule without delay for 2023. Rep. Welch stressed how important this reform is for community pharmacies and the patients they serve. In response to comments from Rep. Carter about the role that pharmacies play, Becerra saluted all the pharmacies who have been real heroes during the pandemic.
Congressional Champions Send Letter to OMB
Urging Prompt Action on Part D Rule
This week, 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.) sent a letter urging the White House Office of Management and Budget to move forward quickly with review of the Centers for Medicare and Medicaid Services’ proposed rule to lower out-of-pocket prescription drug costs for seniors by bringing pharmacy DIR fees under control. They also reiterated the urgency to finalize this rule and implement these reforms without delay for 2023.
NCPA Joins Stakeholders to Urge Additional Funds
for COVID-19 Uninsured Relief Fund
This week, NCPA joined with 66 other patient, provider, retail, and public health organizations in a letter to Senate and House leadership urging that they replenish the HRSA COVID-19 Uninsured Relief Fund as soon as possible as we move into the next phase of the pandemic. HRSA stopped processing claims for testing and treatment on March 22 and stopped accepting vaccination claims on April 5. The letter said that the funding is “essential to upholding critical public health efforts.”
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 need to be submitted by May 25.
Minnesota takes action against CVS/Caremark
for violations of patient protection laws
The Minnesota Department of Commerce initiated enforcement action against CVS/Caremark for violations of the Minnesota Pharmacy Benefit Manager Act. The state is seeking to levy a $1.25 million fine and stop the PBM’s practices that violate Minnesota laws. The Department alleges Caremark required patients to fill maintenance medications at CVS retail pharmacies or Caremark-owned mail-order pharmacies, in violation of state laws protecting patient choice. According to the Department, Caremark’s practices “harm Minnesotans” and “members have needed to drive 20 to 130 miles to get to a CVS retail store, rather than refilling medications at a local non-CVS pharmacy much closer to their homes.” Commerce Commissioner Grace Arnold is quoted saying “This case demonstrates the importance of regulating PBMs in order to protect Minnesotans’ access to the critically important health care that pharmacies provide.”
PBM Bill Signed into Law in Oklahoma
Oklahoma Gov. Kevin Stitt (R) signed SB 737 into law. The legislation protects patients and pharmacies from PBM abuses by giving the insurance commissioner greater enforcement authority over PBMs, prohibiting the practice of spread pricing, and prohibiting pharmacy network participation fees. The legislation follows a recent legal victory (PCMA v. Mulready) in which a federal court found that the federal ERISA law does not preclude the state from enforcing the Oklahoma Patient’s Right to Pharmacy Choice Act. Congratulations to community pharmacy advocates in Oklahoma for these important victories!
NCPA Board Member Christian Tadrus Elected to NCPDP Board
Christian Tadrus, owner of Sam’s Health Mart Pharmacies in Missouri, was recently elected to the board of trustees for the National Council for Prescription Drug Programs. Tadrus serves on the NCPA Board of Directors, is a lead manager of the Missouri Pharmacists Care Network, and also serves on the CPESN® USA Board of Directors from CPESN - Missouri.
CMS Final Rule on ACA Exchanges
On April 28, CMS issued its Final Rule on the Obamacare exchange plans for 2023. The Rule requires that all health insurance providers using state or federal ACA exchanges offer standardized plan options at every product network type, at every metal level, and throughout every service area that they offer non-standardized options in PY 2023 and beyond. Lastly, the rule finalized copays for drugs in standardized plan options. Click here for the CMS press release on the final rule, and here for the fact sheet.
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.