NCPA Advocacy Center Update – Week Ending December 8, 2017

NCPA to testify before key health panel next week: The House Energy and Commerce Subcommittee on Health announced a Dec. 13 hearing entitled “Examining the Drug Supply Chain.” NCPA CEO Doug Hoey is scheduled to testify to share the community pharmacists’ perspective. The hearing is intended to be an educational session to help lawmakers better understand the drug supply chain from end to end. In addition, on Dec. 12 the Senate HELP Committee will hold the third in its series of hearings on prescription drug spending, with focus on a new report from the National Academies of Sciences, Engineering and Medicine. 

Drug price growth slows in 2016: Health care costs increased 4.3 percent and retail prescription drug spending was 1.3 percent higher in 2016, according to a new CMS report released this week on national health expenditures. In the drug category, inflation was down significantly compared to 2014-2015, which CMS attributed to “fewer new drug approvals, slower growth in brand-name drug spending as spending for hepatitis C drugs declined, and a decline in spending for generic drugs as price growth slowed.” 

NCPA told FTC how PBM practices distort the marketplace, offered proposed solutions: The comments follow-up on a presentation by NCPA VP, Policy & Regulatory Affairs, Susan Pilch at a Nov. 8 FTC workshop on the prescription drug market and supply chain. NCPA recommended support for more PBM disclosure of all direct and indirect compensation to ERISA plans to evaluate its reasonableness; FTC-Labor Dept. collaboration to create a standardized definition of “brand”, “generic”, “specialty” and “rebate” to clarify ERISA drug plan designs; more federal/state transparency efforts surrounding PBM generic drug MAC lists; and increased scrutiny of the conflicts of interest that can be attributed to PBMs operating as both a reimburser and competitor in the pharmacy marketplace.

Senate panel to review 2016 law on opioid access: The Senate Judiciary Committee hearing will hold a Dec. 12 hearing to review the Ensuring Patient Access and Effective Drug Enforcement Act, the bipartisan law enacted in 2016 with unanimous votes. The hearing fulfills a commitment Chairman Chuck Grassley made in response to stories in The Washington Post and elsewhere questioning the law. NCPA will monitor the hearing. A witness list is not yet available.

Stopgap budget measure could facilitate CHIP funding: With some states fearful they may exhaust available funding with the Sept. 30 lapse of authorization for the Children’s Health Insurance Program (CHIP), Congress included in a stopgap budget bill a provision granting CMS new flexibility to shift leftover dollars to states in need.

FDA two-day workshop reviews Drug Supply Chain Security Act implementation: Members from NCPA’s advocacy team represented community pharmacists’ interest alongside representatives from industries including the manufacturers, distributors, and other related supply chain actors. Topics for discussion included the overall vision of interoperability of systems for each actor in the supply chain as well as drug product serialization and enhanced verification of serialized product. While much of these issues begin with action from members at the top of the supply chain (i.e., manufacturers), NCPA is actively monitoring the downstream impact on small pharmacies, including discussion with FDA on whether the hardware/software discussed is readily accessible to pharmacies, whether such technology is not prohibitively expensive to small dispensers, and whether the hardware and software can be integrated into existing business practices. This is a long advocacy game for NCPA as FDA looks to have an interoperable system up and running by 2023.

NCPA Attends AIP Texas Town Hall:  NCPA VP, Government Affairs and Advocacy Karry La Violette gave a national legislative update at a Town Hall in Houston, TX hosted by the Alliance of Independent Pharmacies of Texas with AIP members and Texas state Representatives Kevin Roberts (R-126/Houston) and Tom Oliverson (R-130/Houston).  Additionally, Rep. Roberts was presented with a NCPA Political Action Committee (NCPA PAC) contribution for his congressional bid as he is running for Congress in Texas’ second congressional district that is being vacated by Congressman Ted Poe (R).

Proposed CVS/Aetna merger draws critics: The recently proposed CVS/Aetna merger drew concerns from Democrats in Congress, who asked for a congressional hearing and thorough review by regulators. On Friday a CVS spokesman said the company expects the Justice Department to review antitrust concerns, rather than the FTC. NCPA expressed concern about the proposed merger and will continue to monitor the situation.

FDA Commissioner Gottlieb discusses compounding pharmacies: At a consumer group event in Washington, Dr. Gottlieb said the FDA in early January will put forth new policies related to compounding pharmacy. He described the agency as trying to achieve a “gradation of regulation” to better distinguish between smaller pharmacies compounding to meet local need from those engaged in “bulk, mass production.” In addition, testifying before the Senate HELP Committee, he expressed concern about the shortage of manufactured IV fluids because of the crisis in Puerto Rico and agreed that 503B compounding facilities could theoretically help mitigate the immediate shortage. However, he also noted, the manufacturing of plastic IV bags was also devastated by hurricane damage and limited the ability of 503B compounders to help.

NCPA ad reaches decision-makers in Washington: Called “You Should Know,” the ad educates policymakers about the huge impact PBM practices have on patients and pharmacists. For more, read the Dec. 8 Executive Update email. 

Thanks for your help with DIR Day: In conjunction with the new ad mentioned above, NCPA and our allies urged community pharmacists to contact Congress and share how much DIR cost them in 2017. As a result, 2,388 messages have been sent to 393 Hill offices in support of the DIR bill, H.R. 1038 / S. 413. One pharmacist described incurring $100K+ in DIR! Thanks for your help as such grassroots efforts are key to gaining cosponsors and facilitating action.

NCPA presentation on 2018 regulatory issues: If you missed the NCPA Members Forum on the Community Pharmacy 2018 Checklist, a recording and the associated slides are now online for NCPA members (login required).

2018 Senate, House calendars set: Next year’s congressional calendar is now set for both the Senate and House. In keeping with past election years, lawmakers plan more time away to facilitate local campaigning. Remember to save April 11-12 for the 2018 NCPA Congressional Pharmacy Summit. 

In the states:

  • Reimbursement Cuts Continue…and So Do We: NCPA continued to engage and advise pharmacies and state partners this past week regarding the severe MAC reimbursement cuts many of our members are experiencing. In hopes of discerning some patterns, NCPA will work with state partners on a brief state-specific survey of members to help gather data on the scope of the cuts. NCPA has also reached out to CMS. Also, a sample letter is available upon request to assist pharmacies in engaging their local elected officials. With regard to cuts in Medicaid managed care plans, it’s important for pharmacists and state partners to: 1) contact your state Medicaid agency to make them aware of the below-cost reimbursement rates, highlight that these reductions may result in decreased beneficiary access to medication, and point out CMS’s final rule on network adequacy requirements in Medicaid MCOs; 2) re-examine any state MAC laws for their enforceability and applicability to Medicaid MCOs; and 3) consider 2018 legislation to require MCOs to reimburse at FFS rates and subject MCOs to state MAC laws. Use NCPA comments about Medicaid MCOs in your arguments. 
  • NCPA provides recommendations on Oregon proposed PBM regulations: NCPA comments to the Oregon Department of Consumer and Business Services voiced support for the Department’s efforts to adopt rules ensuring the intent of Oregon’s MAC transparency law is faithfully implemented. NCPA comments included support for the proposed definition of “generically available” and a recommended clarification that PSAOs may submit appeals on a pharmacy’s behalf. NCPA also recommended the Department clarify that a MAC price adjustment is effective from the date of initial adjudication pursuant to an upheld appeal.
  • NCPA offers assistance for testimonies in Florida and Texas: NCPA provided presentations and talking points on the importance of PBM transparency legislation for a Florida member and a partner association in Texas to assist with their testimony before legislative committees. The presentations included background on PBMs, information on unfair and anti-competitive PBM practices, and suggestions for legislation that would provide more transparency around PBM practices. NCPA also emphasized the positive economic impact of community pharmacies in the presentation.