National Community Pharmacists Association (NCPA)
Government Affairs Update - Week Ending March 6th, 2010
Health Care Reform: This week, President Obama renewed his call to pass Health Care Reform legislation and House Democrats have begun counting the votes to see if they can pass the Senate version of the bill with limited changes through the reconciliation process (only requires 51 votes in the Senate rather than the customary 60). At this point, it is very unclear if there will be enough votes in the House to pull this off. All eyes are on Easter Recess as the backstop for passage and President Obama is considering cancelling his trip to Indonesia and Australia, so he can continue to lobby for votes. So, the next three weeks could be “make or break” for health reform.
Reminder: The Senate passed bill is very good on NCPA’s key legislative priorities, including Medicaid Pharmacy Reimbursement AMP fix (no less than 175% of average weighted AMP), PBM transparency, MTM. The Senate bill is also more favorable to small businesses relative to requirements to provide health care insurance.
DME Accreditation Exemption: The Senate spent most of the week debating a second job creation bill, which includes a permanent DME accreditation exemption for eligible community pharmacies. The Senate is expected to pass the bill next week and send it to the House for consideration. The Senate DME accreditation exemption would modify the DME accreditation requirements for those pharmacies whose Medicare Part B DME billings are less than 5 percent of their total pharmacy sales. We are optimistic that an accreditation exemption will be enacted sometime this month.
FEHBP PBM Bill: NCPA met with the staff of the House Federal Workforce Subcommittee about some of our concerns with H.R. 4489, the FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act. We discussed community pharmacy’s role in helping to move the bill forward, as well as some concerns we have with certain sections of the bill, particularly those relating to pharmacy reimbursement.
Postal Service Reform: The United States Postal Service (USPS) announced proposals this week for a series of significant reforms to the postal service, which are designed to reduce costs and improve efficiency. One option is to expand the availability of postal services through other community business locations, such as community pharmacies, some of whom already provide postal-related services. NCPA spoke this week with the USPS and will be meeting with them in the near future to explore opportunities for community pharmacies to continue to partner with te USPS as they consider other major reforms.
MTM Grant Program: Even before potential passage of Health Care Reform, NCPA and our coalition partners have begun a lobbying initiative targeted toward funding the proposed MTM grant program, which is included in the healt care reform bill. While this is an uphill battle with Health Care Reform still pending, we believe now is the time to lay the ground work to try and get funding through the Appropriations Committee. This week, we met with the Staff of the Labor HHS Subcommittee, which is chaired by Senator Tom Harkin (D-IA) and oversees the budget for AHRQ. It was a positive first meeting, but this will be an ongoing process.
Restricted distribution of valacyclovir: NCPA is alerting House and Senate Congressional offices as well as regulatory agencies of Ranbaxy’s direct-to-large-chain pharmacy deal, giving them exclusive access to valacyclovir (generic Valtrex). We hope to send a letter through several Members of Congress raising the issue with the Federal Trade Commission. We are also looking at options to address this issue to make sure that generic manufacturers appropriately use the market power given to them during the 180 exclusivity period traditionally given to the first generic to market.
CAT Employee Prescription Drug Plan: NCPA continues to work with Members of Congress from Illinois to seek their help in reversing Caterpillar’s decision to create an incentive-based prescription drug plan for their employees with Walgreens and Wal-Mart. NCPA sent a follow up letter to senior executives at CAT urging them to include independents in their employee prescription plan as soon as possible. We are working closely with the offices of Illinois Members of Congress to find ways to include independent pharmacies in CAT’s Employee Prescription Drug Plan in the near future.
Meeting with FDA on e-REMS Solution: NCPA senior staff met with senior FDA officials this week to impress upon them the need to create a single REMS (Risk Evaluation and Mitigation Strategy) program that can be used for all drugs for which the agency determines a REMS program is needed. NCPA is concerned that the agency will approve different REMS for different drugs, which would create significant administrative hassles for patients, prescribers and pharmacists. We cosigned a letter with APhA and several regional chain pharmacies, encouraging that any REMS program that is developed utilize face to face pharmacist counseling and education of patients, rather than a “call center” approach.
Medicare Part D 2011 Call Letter: NCPA submitted comments to CMS regarding the 2011 Medicare Part D draft Call Letter and the draft Medicare Marketing Guidelines. Comments primarily focused on CMS’ proposal to curb waste of pharmaceuticals by having pharmacies dispense a trial supply of medication to Part D beneficiaries. NCPA notes several concerns with this policy including:
a) operational concerns related to who makes the ultimate determination of partially filling a prescription; b) making sure that appropriate dispensing fees for each fill are addressed and c) that guidance be provided to plans as to what documentation would be required for each trial fill, therefore avoiding problems with audits. We also have concerns that the proposal seemingly ignores how CMS plans to address waste in the mail order pharmacy setting.
Medicare Part D Prompt Pay Law Letter to CMS: NCPA sent a letter to CMS highlighting how certain Part D plans are circumventing the original intent of the prompt pay law enacted in MIPPA by charging pharmacies improper and illegal fees related to Part D transactions and electronic funds transfer. NCPA member pharmacies are reporting that plans are failing to send necessary remittances, charging new prescription transaction fees and electronic funds transfer fees, failing to notify or honor electronic fund transfer options, and creating difficulties for pharmacies in properly reconciling payments when a check may arrive in 14 days but the remittance isn’t sent for an additional one to two weeks. We are also taking with senior Congressional staff about this unacceptable situation to determine potential legislative remedies.
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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