- New York Times and Wall Street Journal Articles Underscore the Need for PBM Reform
- Finish the Fight with NCPA’s Months of Action
- Wyden Pushes CMS for Greater Oversight of PBMs in Adhering to DIR Rule
- CMS Provides FAQs for Pharmacies on Future HIV PrEP Coverage in Medicare Part B
- Twenty-Four Congressmen Send letter to DOD on Express Scripts
- California PBM Bill Continues With Unanimous Support
- South Carolina and Ohio State Legislatures Advance Expansion of Immunization Authorities
- NCPA State Legislative Activity Update
New York Times and Wall Street Journal Articles Underscore the Need for PBM Reform
Last week, the New York Times published the first in what it says is a seriesinvestigating PBM business practices. This week, the Wall Street Journal is getting in on the action. “Drugs delivered by mail are costing multiples more than those picked up at a store counter,” reports WSJ’s Jared S. Hopkins, which is raising employers’ spending. “Markups were as much as 35 times higher than what other pharmacies charged, according to a recent analysis of millions of prescriptions in Washington state.” The study was commissioned by the Washington State Pharmacy Association. NCPA’s position on mail-order pharmacy has been clear for decades, and consumers, employers and public health officials should consider the potential risks before they allow PBM-insurers to steer patients into mail order. This Washington study can be a valuable tool when advocating for policies to protect patients, employers and taxpayers from the super-predators inflicting so much harm. Help amplify these articles by sharing them with your legislators and patients.
Finish the Fight with NCPA’s Months of Action
A package of PBM reforms made it right to the goal line in March, but due to unrelated issues, it was not included in the government funding package. Your continued engagement is necessary to ensure Congress finishes the fight and passes robust PBM reforms! Hosting legislators or their key staff for a visit to your pharmacy and meeting with them face to face is the best way to convey the urgency of pushing robust PBM reforms across the finish line. This year, members of Congress are scheduled to be away from Washington during the entire months of August and October, providing tremendous opportunities to host them in your pharmacy. Click here for resources on our Months of Action. You can also let us know of your interest in participating by completing this interest form or by emailing Michael Rule at mrule@ncpa.org.
Wyden Pushes CMS for Greater Oversight of PBMs in Adhering to DIR Rule
Sen. Ron Wyden (D-Ore.), chairman of the Senate Committee on Finance, sent a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure this week asking the agency to increase enforcement of Medicare Part D program requirements for PBMs and to protect pharmacies from unfair PBM practices, specifically PBM violations of the rule that took effect the beginning of this year seeking to rein in DIR fees. He also asked that CMS take a series of concrete steps to address the problem, including enforcement of “any willing pharmacy” requirements by ensuring that PBMs reimburse pharmacies at a minimum of the cost to acquire and dispense covered prescription drugs; implementation of standardized pharmacy measures including the evaluation and reporting of plan performance measures; and reviewing complaints about PBM contracting practices under Part D over the past 18 months. NCPA has been active in seeking relief for our members, having alerted CMS of Express Scripts’ bad practices ... which CMS then confirmed violated the DIR rule and led to ESI terminating its “bonus pool” fee program.
CMS Provides FAQs for Pharmacies on Future HIV PrEP Coverage in Medicare Part B
The Centers for Medicare & Medicaid Services (CMS) released a frequently asked questions (FAQ) document for pharmacies regarding the Preexposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV National Coverage Determination (NCD) in Medicare Part B expected to be made public and effective in late September 2024. The FAQ addresses background, enrollment, and billing information.
The final NCD is expected to be similar to the proposed NCD that was published on July 12, 2023, and CMS advises pharmacies to be prepared for this transition. CMS is sharing as much information as possible before issuing the final NCD to avoid disruptions for beneficiaries.
The FAQ document is in follow up to CMS’ publication of a fact sheet in May 2024. NCPA submitted comments on the proposed NCD back in August 2023.
Twenty-Four Congressmen Send letter to DOD on Express Scripts
This week, two dozen Members of Congress sent a letter to Assistant Secretary of Defense for Health Affairs Martinez-Lopez and the Director of the Defense Health Agency, Lieutenant General Crosland regarding the concerns of Express Scripts (ESI) in their running of the TRICARE pharmacy program and calling for answers. The calls, led by Sens. Elizabeth Warren (D-Mass.) and Reps. Buddy Carter (R-Ga.), highlighted the bipartisan concern that the second largest PBM in the nation is both administering the program and a participant in it, raising trepidation that they are using this exclusive contract to overcharge taxpayers and drive out competition at the expense of our service men and women. In August 2022, 15,000 pharmacies left the TRICARE network impacting 400,000 military families. This spring EPIC, one of two remaining Pharmacy Service Administrative Organizations in the TRICARE network, announced that their more than 1,000 pharmacies will be leaving the network this summer. The loss of health care access is untenable for our uniformed men and women. We applaud the Senators and Representatives for holding the Department of Defense and ESI accountable preserve patient access to medications and pharmacies.
California PBM Bill Continues With Unanimous Support
California SB 966 was passed unanimously by the Assembly Health Committee on Tuesday, June 25. The hearing featured compelling testimony from NCPA member and Pucci’s Pharmacy owner Clint Hopkins and strong championing from bill author Senator Anthony Wiener. A wide range of organizations voiced support for the bill, most notably the California Medical Association, California State Association of Psychiatrists, California Rheumatology Alliance, AIDS Healthcare Foundation, and PhRMA. NCPA continues to support the California Pharmacists Association with grassroots and policy information behind the scenes and submitting commentsthroughout the committee process. SB 966 now proceeds to the Assembly Judiciary Committee.
South Carolina and Ohio State Legislatures Advance Expansion of Immunization Authorities
Two states have passed bills out of their respective legislative branches expanding pharmacy scope of practice: H 3988 in South Carolina allows pharmacists administer immunizations to individuals 12 and older and to initiate CLIA-waived tests for COVID-19 and flu; SB 144 in Ohio authorizes pharmacists to administer immunizations to patients 5 years and older and eliminates the requirement of a prescription to administer a vaccine for children under the 13. Both make changes for pharmacy technicians with H 3988 granting new vaccination permissions and SB 144 includes technicians to administer vaccines to individuals 5 and older.
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.