National Community Pharmacists Association (NCPA)
Government Affairs Update - Week Ending July 31st, 2010
Community Pharmacy Priority Legislation - HELP US HELP YOU - GENERATE CONGRESSIONAL INTEREST!
· PBM Reform: The Next Steps: H.R. 5234, the PBM Audit Reform and Transparency Act of 2010 was recently introduced by Reps. Weiner (D-NY) and Moran (R-KS). This legislation expands the new PBM transparency requirements included in the health care reform bill to all plans both public and private plans. It is also the first federal legislation to try and reform PBM’s abusive auditing practices.
· DME Accreditation Exemption and Competitive Bidding: H.R. 5235, the Medicare Access to Diabetes Supplies Act was recently introduced by Reps. Welch (D-VT) and Rogers (R-MI). This legislation would exclude diabetic supplies provided by small pharmacies from DME competitive bidding. The bill defines small pharmacies using the SBA definition of $7 million or less in annual sales. Excluding these supplies from competitive bidding is important for small pharmacies because they will unlikely be able to effectively participate in the competitive bidding program. That will reduce beneficiaries' access to diabetes testing supplies.
We ask all community pharmacists to contact their Members of Congress and ask them to cosponsor these important bills. We are looking to identify Senate sponsors of this legislation.
· Congress at Home: Talk with your Member!: The House of Representatives adjourned this week for its summer recess, but the Senate will not adjourn till the end of next week. Congress comes back into session in mid September and will be in Washington for about 4 weeks until they adjourn for the midterm elections.
While Members of Congress are back home in their districts, make sure you take time to talk with them about community pharmacy priorities. Make sure they understand the Federal legislation or policies you would like them to support for your patients and your pharmacy business. Invite them in to see your pharmacy. NCPA has prepared the attached “community pharmacy platform” document, which we urge that you use when talking with your Members of Congress as well as your patients.
Senate Vote on Enhanced Medicaid Funding Extension: Congress has been unable to come to agreement on a plan to extend the enhanced Medicaid matching funding to the states, although there is bipartisan support from the governors. The enhanced funding ends at the end of this year, although it is right in the middle of most states’ fiscal years. Senate Majority Leader Harry Reid (D-NV) intends to try and pass a $19 billion FMAP extension on Monday, which is partially offset by a requirement that manufacturers pay rebates on infusion, injection and inhalation drugs paid for by Medicaid. NCPA is supporting an extension in funding because of the potential that states will be forced to reduce reimbursement to providers if the additional funding is not extended. Even if the Senate passes the bill, the House would not vote on it until September. While almost all Senate Democrats are expected to vote for the bill, several Republican Senators are being targeted to help achieve the 60 vote threshold. These include Senator Collins (ME), Snowe (ME), Brown (MA) and Voinovich (OH). NCPA will be encouraging offices to support the package.
· FDA REMS Meeting: NCPA offered recommendations to the FDA at a two-day public meeting this week that was held to solicit input as the agency designs and implements REMS. NCPA presented on each day of the meeting, discussing topics such as the need for a common REMS platform, the perils of placing REMS drugs in restricted distribution or “specialty” pharmacy arrangements, and the need for metrics to determine the effectiveness of any given REM S program - to be clearly defined before program is implemented. Next steps include the FDA considering all input to the open docket up to the August 31 deadline. The FDA will strongly consider incorporating any suggested comments into REMS currently under development.
· DEA Controlled Substance Take Back Day: NCPA confirmed with the DEA details of their September 25th nationwide drug Take-Back Day. This event is strictly law enforcement related and the DEA can’t partner with registrants – such as pharmacies - for the event. Locations where the take back events will be held are dependent on different regional divisions within DEA and they are encouraging the events to be held in very public areas such as malls, grocery store parking lots, etc. NCPA members who may want to partner with local law enforcement to host an event in their parking lot for example (it can’t be held within pharmacy itself) should let NCPA know of their interest. We will collect the information and share with the DEA who will provide us specific contact information. DEA will launch a big media blitz next week concerning this event.
· NCPA Working with NFIB on 1099 Modification: On July 28, NCPA participated in a meeting of the NFIB Small Business Coalition for Affordable Healthcare. The NFIB Coalition discussed legislative and regulatory efforts to repeal or narrow the expanded 1099 reporting requirements for small businesses under the new health care reform legislation. The efforts to repeal this requirement appear to be picking up steam. Several amendments were offered to legislation in both the House and the Senate this week by Congressman Dave Camp (R-MI) and Senator Mike Johanns (R-NE) that would have eliminated the requirement. This Section mandates that, beginning in 2012, all companies will have to issue 1099 tax forms not just to contract workers, but to any individual or corporation from which they buy more than $600 in goods or services in a tax year. Currently, 1099s are just used to document income for individual workers for services other than wages and salaries, not used for corporations or for the purchasing of goods.
· Meaningful Use of EH Records: On July 22, NCPA participated in a CMS Open Door Forum on HHS’ Final Rule on the Electronic Health Record (EHR) Incentive Program. CMS explained what is included in the EHR Final Rule and how the Final Rule differs from the Proposed Rule. CMS particularly emphasized “meaningful use,” defining the term and elements of “meaningful use” and laying out the stages for implementing “meaningful use.” CMS also discussed the timeline for the EHR incentive program and provided an overview of the incentive payments. NCPA will continue to be engaged in the “meaningful use” discussion, especially as it relates to pharmacy information contained in an EHR and our work as part of the Pharmacy e-HIT Collaborative.
· Program Integrity Issues: NCPA is preparing for a meeting with the new CMS Office of Program Integrity to talk about community pharmacy’s experiences with Medicare and Medicaid fraud, waste and abuse initiatives. We will be focusing on Part D issues, such whether Part D prescriptions really need to be retained for 10-years, as well as current fraud waste and abuse training; the equity of current Part B recoupment activities for DME supplies; and the need for greater oversight of PBMs in Part D. Members are encouraged to send us specific examples of abusive auditing or FWA practices in Federal government programs.
· Long Term Care: NCPA continues to work on the 2012 Part D requirement that plans use methods to reduce waste in long term care dispensing. This week, NCPA participated on a NCPDP short cycle conference call. NCPDP is currently looking at how such short cycle billing will be done under existing billing standards. CMS’ proposed regulation on this topic is scheduled for initial publication in late August.
NCPA also spoke with the Ohio Board of Pharmacy to discuss the “nurse as agent” issue relating to the prescribing and dispensing of controlled substances in LTC facilities. The Ohio BOP just sent a draft of its proposed solution to the DEA for approval. Ohio’s waiver request includes facility registration with the DEA as well as a requirement for the facility to purchase and be responsible for controlled medication stock instead of getting these medications from a pharmacy provider. NCPA’s solution asks DEA to recognize an agency relationship between the facility and pharmacy. As a result, the nursing home itself does not need to purchase the medications. DEA is currently asking for comments on a wide range of topics relating to this issue so they can determine what their next steps might be.
- HRSA Patient Safety Collaborative: On July 27, NCPA participated in a HRSA webinar on the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) 3.0. HRSA representatives explained the benefits of the program, the requirements to be a part of the program and the health care outcome results from the initial rounds of the program, including highlighting some success stories. The deadline for teams to participate in the PSPC 3.0 has been extended to August 15, 2010.
· TRICARE Generic Drug Reimbursement: NCPA understands that ESI may have significantly decreased the generic reimbursement for some DOD TRICARE prescriptions. NCPA is interested in hearing if pharmacies have seen a recent sudden drop in generic reimbursement. We do not want specific reimbursement rates, just information about whether rates have changed. NCPA will be pursuing a meeting with TRICARE to talk about this issue, but would like to hear more evidence about what might be going on in the field.
· NCPA Political Activities: Among the various political activities in which NCPA staff participated in this past week were fundraisers for Democratic Senate Candidate Richard Blumenthal (D-CT), Congressman Dan Lungren (R-CA), Congressman Fred Upton (R-MI), and House Minority Whip Eric Cantor (R-VA). NCPA also cohosted with NFIB a large fundraising dinner for House Minority Leader John Boehner (R-OH), who is in line to become Speaker if the Republicans take back control of the House.
John M. Coster, Ph.D., R.Ph.
Senior Vice President, Government Affairs
National Community Pharmacists Association
100 Daingerfield Ave
Alexandria, VA 22314
703-683-8200 X184 - office
571-214-3936 - cell
john.coster@ncpanet.org