• Press the Urgency of PBM Reform With Your Members of Congress 
• Krishnamoorthi and Harshbarger Address PBM Abuses in Federal Health Plans
• NCPA Webinar will Provide State Legislative Updates
• NCPA Submits Comments to HHS, Calling for De-regulation by CMS, DEA/SAMHSA, FDA
• Arkansas Judge Accepts Joint Amicus Brief from NCPA and Arkansas Pharmacists Association
• Iowa Court Rejects Amicus Brief from Pharmacy Stakeholders
• NCPA touts patient alignment at NCOIL
• Reimbursement Round Up 
• NCPA State Legislative Activity Update

Press the Urgency of PBM Reform With Your Members of Congress

Engage with your legislators and demand prompt action on PBM reform, particularly the following pro-pharmacy provisions that ae included in the PBM Reform Act (H.R. 4317) and have companion language in the Senate:

Medicaid managed care payment reform through enhanced transparency and a ban on spread pricing by reimbursing pharmacies at a rate equal to the national average drug acquisition cost (NADAC) plus the state's fee-for-service dispensing fee. This would also save taxpayers nearly $3 billion. In the Senate, this is included in the Protecting Patients in Medicaid Act (S. 927)

Medicare D contract reforms that require CMS to define and enforce reasonable and relevant contract terms in Part D, including terms related to reimbursements, and requires CMS to establish a mechanism for pharmacies to report violations. In the Senate, this is included in the Patients Before Middlemen (PBM) Act (S. 882).

Also, Congress will be away from Washington July 25-Sept. 1. This is an opportune time to invite your legislators to visit your pharmacy and advocate for these commonsense reforms face-to-face. Click here for resources on NCPA's Month of Action or let us know of your interest in hosting a pharmacy visit by completing this interest form or by emailing Michael Rule at mrule@ncpa.org. Keep the pressure on Congress to finish the job!

Reps. Krishnamoorthi and Harshbarger Address PBM Abuses in Federal Health Plans

This week, Reps. Raja Krishnamoorthi (D-Ill.) and Diana Harshbarger (R-Tenn.) introduced the Fair Pharmacies for Federal Employees Act (H.R.4409), legislation to protect federal employees and retirees from anti-competitive practices by pharmacy benefit managers and insurers. NCPA was proud to endorse this legislation which prohibits the Office of Personnel Management from contracting with entities—such as PBMs—that both manage prescription drug benefits and own or control a pharmacy in the Federal Employee Health Benefits Program (FEHBP).

Specifically, the Fair Pharmacies for Federal Employees Act:

- Prohibits federal employee health plans from contracting with entities that own or control both PBMs and pharmacies;

- Targets patient steering, anti-competitive reimbursement practices, and conflicts of interest within FEHBP;

- Applies to all types of pharmacies, including mail-order, specialty, and retail; and

- Reinforces federal and state oversight without limiting enforcement tools.

The federal government runs the largest employer-based health care system in the country, and with comprehensive reform such as this at the federal level it will work hand in hand with similar models in states like Arkansas, who passed legislation this year. Addressing the inherent conflicts of interest that exist in these vertically integrated PBMs/insurers will lower health care costs and preserve access for patients

NCPA Webinar will Provide State Legislative Updates

PBM reform, Medicaid managed care reform, and expanded scope of practice have been hot topics in state legislatures this year. Join NCPA's Joel Kurzman and Belawoe Akwakoku on July 24 at 2 p.m. ET for a webinar as they unpack the momentum behind these impactful pharmacy policy trends.

This session will provide a deep dive into how state-level advocacy continues to reshape the pharmacy landscape by exploring the legislative development around PBM reform, Medicaid managed care reform, and expanded scope of practice made this year. Register here.

NCPA Submits Comments to HHS, Calling for De-regulation by CMS, DEA/SAMHSA, FDA

NCPA submitted comments to HHS, calling for de-regulation from the Centers for Medicare & Medicaid Services, Drug Enforcement Administration/Substance Abuse and Mental Health Services Administration, and the Food and Drug Administration.

NCPA requested that CMS eliminate pharmacies' mandatory participation in the Medicare Drug Price Negotiation Program via PBM/plan contracts, and rescind the Medicare Part B requirement for a beneficiary's signature on a reimbursement claim.

NCPA's ask to SAMHSA and DEA was that these agencies should rescind joint rules requiring pharmacists to verify the identity of patients filling prescriptions for buprenorphine to treat opioid use disorder that were issued on the basis of a telemedicine encounter.

NCPA asked the FDA to de-regulate compounding, including that the agency suspend its MOU with state boards of pharmacy indefinitely, given our multiple concerns; eliminate its proposed rule on demonstrable difficulties for compounding; and rescind its 2023 Guidance for Industry #256 (GFI 256) governing compounding of animal drugs.

NCPA also asked the FDA to modify its Nonprescription Drug Products with Additional Conditions for Nonprescription Use (ACNU) final rule to standardize the ACNU process and incorporate the role of the pharmacist.

Arkansas Judge Accepts Joint Amicus Brief from NCPA and Arkansas Pharmacists Association

On Tuesday, a federal judge granted NCPA and the Arkansas Pharmacists Association's request for leave to file an amicus brief in support of Arkansas' defense of Act 624. Nearly every major PBM and their affiliated insurers have sued to negate this act, including ESI/Accredo/Cigna, CVS/Caremark/Omnicare /Aetna, PCMA, Navitus (Lumicera/Costco/SSM Health), and OptumRx/Genoa/UHG. The clear purpose of this act was to address the inherent conflicts of interest and resulting harms to plan sponsors, patients, and pharmacies arising from when PBMs own and operate their own pharmacies. 

PBMs are large, powerful, and resourceful. They are duty-bound to maximize profit and preventing their profit-maximizing and harmful business practices has proven to be the proverbial game of Whac-A-Mole. The Arkansas legislature and governor had an obligation to act in the best interests of the state, not PBMs' shareholders, and they ultimately concluded that PBM ownership of pharmacies was the root of the problem. NCPA and APA couldn’t agree more. To read our combined brief, please see here. 

Iowa Court Rejects Amicus Brief from Pharmacy Stakeholders

Last Tuesday, a federal judge denied a combined NCPA-led effort with the Iowa Pharmacy Association, APhA, and IPC to submit an amicus brief in support of Iowa’s defense of its PBM reform bill, SF 383. The law is being challenged by a group of employers who believe that the newly enacted law will raise health care costs. (Where have we heard that before??) After waiting over two weeks to seek emergency injunctive relief, the plaintiffs challenged eight provisions that regulate third-party payers and 16 more that apply solely to PBMs. This was all done on a compressed schedule of their own making and their combined pleadings tallied over 100 pages. NCPA and our partners felt that this kind of challenge could not go unanswered by the folks who are directly impacted by such a grave misunderstanding of the positive impact that PBM reform legislation can have on competition, prices, affordability, quality, and access. To read our combined brief, please see here. 

NCPA touts patient alignment at NCOIL

NCPA attended the summer meeting of the National Conference of Insurance Legislators (NCOIL) in Chicago. At NCOIL’s invitation, NCPA and National Association of Chain Drug Stores jointly represented the pharmacy perspective in a panel program about Prescription Drug Affordability Boards (PDABs). PDABs are entities established in seven states to evaluate and manage the costs of prescription drugs. They conduct affordability reviews of drug prices and spending, and develop strategies to control costs, including the use of Upper Payment Limits (UPLs). 

In brief summary, the NCPA and NACDS presentation emphasized pharmacy’s alignment with the patient in seeking lower cost drugs options and shared the problems associated with how PDABs establish UPLs that don’t take into account how pharmacies acquire drugs and the imperative of reimbursement for both the product and the pharmacy’s cost to dispense. NCPA will seek to amend UPL language in PDAB legislation but will join coalition efforts to oppose bills if pharmacy reimbursement concerns are not addressed. 

Reimbursement Round Up

California SB 41 advanced unanimously through the Assembly Judiciary Committee on Tuesday.  The newest version of the bill was stripped of its commercial market reimbursement provisions that required NADAC plus a professional dispensing fee based on the state’s Medicaid fee-for-service rate.  NCPA will advocate for the reinstatement of those provisions moving forward.  NCPA submitted comments in support of Massachusetts H 1390, legislation that would codify the current Medicaid policy of reimbursing independent pharmacies in the managed care and accountable care organizations at the fee-for-service rate.  At the summer meeting of the National Conference of Insurance Legislators, NCPA presented pharmacy perspective about Prescription Drug Affordability Boards and their use of Upper Payment Limits (see above). 

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.