NCPA Advocacy Center Update – Week Ending February 16, 2018

PBM industry concentration questioned as Senate, House review health care industry: At a House Energy and Commerce Subcommittee on Oversight and Investigations hearing on concentration in the health care system, concerns raised by NCPA about the PBM marketplace was one of the dominant themes. Subcommittee Ranking Member Rep. Diana DeGette (D-Colo.), explored whether PBM consolidation contributed to higher prices for insulin. Rep. Morgan Griffith (R-Va.) echoed the concern. Rep. Buddy Carter (R-Ga.), lamented that PBM and drug store consolidation has adversely impacted patient access to their preferred local pharmacy provider. The witnesses, academic experts, noted that PBMs are the least transparent entities in the health care system. NCPA sent a letter for the record explaining that PBM consolidation is contributing to higher drug costs and creating access barriers for patients. Separately, and also reflecting in part NCPA’s continuous efforts to engage policymakers, the Senate Committee on Commerce, Science, & Transportation also discussed PBM consolidation at the confirmation hearing for four Federal Trade Commission nominees. Sen. Shelley Moore Capito (R-W.Va.) questioned PBM conflicts of interest as well as leveling the playing field for community pharmacies; Sen. Roger Wicker (R-Miss.) added questions about the lack of PBM transparency and the negotiation leverage PBMs have over other players in the drug supply chain; and Sen. Richard Blumenthal (D-Conn.) related increasing drug prices to consolidation in the industry. Reflecting the theme, Axios later reported, “[i]f there’s one area where politicians of all stripes are inclined to agree, it’s pharmacy benefit managers. Republicans and Democrats have both expressed concern about three companies controlling more than 75 percent of the market.” Read more in NCPA’s blog post.

Trump Administration released budget “wish list” for fiscal year 2019: Of particular note, the budget announced Feb. 12 focused on increased oversight of opioid prescriptions and expanded treatment options as well as a proposal to evaluate the sharing of a portion of manufacturer rebates with Medicare beneficiaries at point-of-sale. The Department of Health and Human Services (HHS) released an accompanying briefing in support for the budget, arguing that specifically the requirement for Part D plans to apply a substantial portion of rebates and price concessions at the point-of-sale would lead to greater price transparency, realigned incentives and allow beneficiaries to share directly in the savings from discounts negotiated by the plans, while acknowledging that overall program costs could increase. This is encouraging language, but it is important to remember that the President’s budget serves as mainly a framework for policy goals, most of which are subject to Congressional action. Read more on NCPA’s initial reaction.

Pharmacy issues raised at Congressional hearings to examine the budget: Congress held three separate hearings to examine the proposed budget for HHS at which new Secretary Alex Azar testified. On prescription drug prices in Medicare Part D he described five priorities: re-direct at least one-third of rebates to point-of-sale instead; establish an out-of-pocket maximum for beneficiaries; reverse the current ratio for catastrophic costs, of which about 80 percent are borne by the government and the rest by plan sponsors; waive copayments for generic drugs for low-income beneficiaries; and give plans more flexibility to negotiate against drug companies. During one House hearing, he expanded, calling for the need to “straighten out incentives that too often serve program middlemen.” At another House hearing, Rep. Buddy Carter (R-Ga.) walked the Secretary through pharmacists’ concern over pharmacy DIR fees and asked him to look into the issue. Carter also raised concerns with the lack of PBM transparency concerning manufacturer rebates.

Come give Congress a piece of your mind about PBMs: Be part of the NCPA Congressional Pharmacy Summit April 11-12 in Alexandria, Va. Community pharmacists will storm Capitol Hill and make their voices heard on DIR fees, MAC transparency and more. Sign up today:

Opioid epidemic roundup:

  • NCPA offers Senators recommendations how community pharmacists can help: In a letter (attached) to leaders of the Senate Finance Committee responding to their request for proposals, NCPA called for limits on days supply for certain controlled substances; more electronic prescribing of controlled substances; greater access to and pharmacist involvement in medication-assisted therapy; additional health care provider education and enactment of pharmacist provider status legislation (S. 109 / H.R. 592)
  • The Drug Enforcement Administration launched a new tool to “allow the more than 1,500 DEA-registered manufacturers and distributors to view the number of competitors who have sold a particular controlled substance to a prospective customer in the last six months.” As an example the agency said a query which resulted in a large number of suppliers who have recently sold opioid analgesics to a prospective purchaser could represent a “red flag” to the new distributor and foster a dialogue between that distributor and the pharmacy.
  • NCPA monitored events around town related to opioid epidemic. At an event organized by The Hill, Sen. Sheldon Whitehouse (D-R.I.) described the growing potential for legislative action (he labeled as “CARA 2.0”), while Rep. Dave Joyce (R-Ohio) touched on the importance of interoperability of state PDMPs. At a separate Duke University event, FDA Commissioner Scott Gottlieb, M.D. focused on greater use of blister packs and more international mail checks. FDA’s Opioid Steering Committee chief observed that opioid prescribing is going down but usage is not, questioning prescribing’s role in the problem and said pharmacists’ comments to FDA have focused on access issues and has been helpful feedback for FDA.

HHS Inspector General may examine DIR reporting: NCPA staff observed the work plan for the department’s watchdog was recently updated to add an anticipated review of DIR in Medicare Part D.

NCPA member webinar on 2018 priorities available: If you missed the Feb. 14 webinar on NCPA priorities for the year, we posted a recording online.

Help inform NCPA comments to CMS on mail order waste: CMS recently proposed changes to its approach concerning patient consent requirements for auto-shipped medication in Part D. Please answer a few questions as we prepare comments to the agency.

In the states:

  • NCPA to present at Insurance Legislators meeting – At its March 4 meeting in Atlanta, the National Conference of State Insurance Legislators will consider creating model PBM licensing/regulatory legislation. NCPA has been invited to make a presentation to NCOIL’s Health Committee, as have PCMA, AHIP and a representative from the Arkansas Pharmacists Association.
  • NCPA provided testimony via telephone to the Alaska House Finance Committee in support of HB 240, which contains provisions on PBM registration, generic drug pricing transparency, and fair pharmacy audit practices.
  • NCPA submitted written testimony to the Arizona House Health Committee in support of HB 2107, which prohibits PBMs from restricting pharmacists from providing information to patients on medication costs, charging patients a copay higher than the total submitted charges, and restricting pharmacies from providing 90-day fills.
  • South Dakota SB 141, which prohibits PBMs from restricting pharmacists from providing information to patients on medication costs, passed the South Dakota House this week and will be sent to the Governor to sign. NCPA provided a letter of support for the bill and commends the South Dakota Pharmacists Association for its hard work in advocating for pharmacists and pharmacy patients.
  • Florida HB 351, which NCPA has provided input on, passed all House Committees and is headed to the House floor.