NCPA Advocacy Center Update – Week Ending January 26, 2018

21 Senators urge CMS to adopt revisions to pharmacy DIR fees: U.S. Senators Shelley Moore Capito (R-W.Va.) and Jon Tester (D-Mont.) organized a letter expressing bipartisan support to CMS for its proposed approach to pharmacy DIR fees. NCPA staff led a concerted effort, along with our pharmacy stakeholder allies, to generate support for the letter and against strong opposition from PBM advocates. The following Senators also signed the letter: Sens. John Boozman (R-Ark.), Bill Cassidy, M.D. (R-La.), Thad Cochran (R-Miss.), Susan Collins (R-Maine), Tom Cotton (R-Ark.), Steve Daines (R-Mont.), Joni Ernst (R-Iowa), Chuck Grassley (R-Iowa), Heidi Heitkamp (D-N.D.), John Hoeven (R-N.D.), John Kennedy (R-La.), Angus King (I-Maine), James Lankford (R-Okla.), Joe Manchin (D-W.Va.), Jerry Moran (R-Kan.), David Perdue (R-Ga.), John Thune (R-S.D.), Thom Tillis (R-N.C.), and Roger Wicker (R-Miss.).

The letter made big waves around Washington. Barely one hour after the Senators announced it, a leading news outlet, Politico, sent a “breaking news”-style update, alerting email in-boxes across town. Inside Health Policy, another key D.C. publication, picked it up as well.

House letter by Reps. Peter Roskam (R-Ill.), Bill Johnson (R-Ohio) opposes CMS Part D proposal: PBM advocates and affiliated organizations urged House lawmakers to join this opposition letter to CMS. NCPA and others aggressively urged members not to sign that letter. Thanks NCPA’s hard-working staff and all NCPA members and allies that helped support both of these grassroots efforts.

Separately, House Ways & Means Chair Kevin Brady (R-Texas), House Energy & Commerce Chair Greg Walden (R-Ore.) and Senate Finance Chair Orrin Hatch (R-Utah) wrote CMS to ask that the agency follow a separate rulemaking process before adopting any changes to regulating manufacturer rebate and pharmacy DIR fees in Medicare Part D. Meanwhile, HHS touted the proposed Part D rule in a new report “highlighting accomplishments from 2017”. It noted the potential savings for “seniors at the pharmacy counter” and separate provisions, NCPA also supports, “revising the pharmacy participation rules in Part D, promoting greater participation of local pharmacies and expanding beneficiary access to all types of pharmacy delivery services, including mail-order” by community pharmacies.

NCPA member Jake Olson to testify about compounding at House hearing: NCPA was invited to testify at a Jan. 30 hearing of the House Energy & Commerce Committee’s Health Subcommittee entitled “Examining Implementation of the Compounding Quality Act”. Appearing on behalf of NCPA members is Jake Olson, Pharmacist and owner of Skywalk Pharmacy in Milwaukee, Wisc., and a member of NCPA’s Compounding Steering Committee. After hearing from FDA Commissioner Scott Gottlieb, M.D., lawmakers will listen to a panel featuring Olson and witnesses from PharMEDium Services; the American Academy of Dermatology; a patient harmed by the NECC fungal meningitis outbreak; the International Academy of Compounding Pharmacists; The Pew Charitable Trusts; Fresenius Kabi; and the American Academy of Ophthalmology. Olson’s written testimony, and that of most witnesses, is now available online. Among other points, Olson’s testimony stresses the critical role compounding plays in meeting unique patient needs and, at times, during drug shortages; highlights both non-sterile and sterile compounded office-use products that community healthcare providers rely on from NCPA members; and outlines recommended changes in FDA’s approach. Related: The Justice Department announced Jan. 25 that it will stop “using its civil enforcement authority to convert agency guidance documents into binding rules,” a change that could potentially impact FDA’s existing approach to compounding, which has relied in part on guidance documents.

NCPA meets with key TRICARE official: This week the NCPA Advocacy Center met with David W. Bobb, chief of the Defense Health Agency’s Pharmacy Operations Division to discuss TRICARE pharmacy issues of importance to our members. Namely, Sec. 714 of the FY18 National Defense Authorization Act that requires regular updating of prescription drug pricing standards under the TRICARE retail pharmacy program. The Division is ensuring this new requirement is implemented correctly. We also discussed the future of a potential TRICARE Acquisition Cost Parity Pilot Program for retail pharmacy as well as copay changes to the program that will occur Feb. 1. Most notably, mail order copays for generics will increase from $0 to $7. Another change discussed was a recent decision to make sure that 75% of a TRICARE patient’s mail medication had to be consumed before a refill could be ordered. This was an increase from 66% due to any potential for waste via the mail. NCPA will continue to dialogue with the Division regarding ways to increase access to community pharmacies within the network, understanding the incentives surrounding the savings associated with brand name drugs in the mail and MTF channels.

Short-term budget deal re-opens federal government, extends CHIP, suspends health insurance tax: The measure approved by Congress and signed into law funds the government through Feb. 8 and also re-authorizes the Children’s Health Insurance Program for six years. In addition it suspended certain taxes implemented under the Affordable Care Act, including lifting the health insurance tax (HIT) for 2019. As part of the Stop the HIT Coalition, NCPA advocated for suspending the tax, which impacts 29 million small businesses and their employees.

Electronic prior authorization (ePA) bill introduced in House: H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, was introduced by Reps. David Schweikert (R-Ariz.), Bill Johnson (R-Ohio), Ben Ray Lujan (D-N.M.), and Mike Thompson (D-Calif.). Sponsors described their intent as to standardize ePA in Medicare Part D and improve beneficiary access to mediation. NCPA is monitoring the legislation.

PBM forum videos, paper available online: A half-day National Press Club forum NCPA co-sponsored along with the Center for Medicine in the Public Interest examined significant barriers, mostly associated with PBMs, to prescription drug access. CMPI has posted online video and written summaries of the event. Review them for use in 2018 advocacy efforts.

NCPA raises community pharmacy priorities in response to committee request: In follow-up to NCPA CEO Doug Hoey’s testimony before the Dec. 13 House Energy & Commerce Committee’s Health Subcommittee hearing, “Examining the Drug Supply Chain” lawmakers submitted a range of questions for the record. NCPA utilized the opportunity to touch on key issues including pharmacy DIR fees; limited pharmacy networks; inadequate MAC reimbursement and more.

Senate confirms Azar as next HHS Secretary: Six Democrats voted with nearly all Republicans to confirm Alex Azar to be HHS Secretary. In voting no, senior Democratic Senators opposed the nomination largely to raise objection to various Trump Administration health care policies and positions. Sen. Rand Paul (R-Ky.) voted against the nomination in protest of restrictions on drug reimportation.

Webinar to examine tax law’s impact on community pharmacies: Join a Jan. 31 webinar to hear from leading community pharmacy accounting firm Sykes & Company, P.A. on its analysis of the recently enacted tax law. Register here.

New Medicare cards start arriving in April:  CMS will roll out new Medicare cards for all Medicare recipients – with new ID numbers (eliminating Social Security numbers) – starting in April. Here’s a toolkit you can use to get more information about the upcoming changes and get the word out to your patients via your website and social media.

In the states:

  • Promises, promises in PA and MD…: We learned last week that Caremark had agreed to reinstate reimbursement rates to pre-October levels for the two plans it administered in Pennsylvania. Those reinstatements were to begin January 13, and the reports last week were that some pharmacists were seeing the changes, but that the application was spotty, and many weren’t seeing any change at all. This week, the news is a bit grimmer: few additional Pennsylvania pharmacists have seen the reinstatements, and some who had seen reinstatements have now seen additional cuts. Similar word of promised reinstatements had come from Maryland. As of earlier this week, adjustments have been spotty there, too.
  • In the meantime: To help prevent these cuts in the future, NCPA is urging state partners to take one or more of these actions during the 2018 legislative session:
    • Amend the state’s MAC law to explicitly state that the law applies to Medicaid Managed Care organizations.
    • Explicitly to prohibit reimbursements under Medicaid Managed Care that are less than the fee-for-service rate (in other words, making FFS rates the reimbursement floor under MMC).
    • In statute carve the prescription drug benefit out of MMC entirely and require that it be administered by your state Medicaid at FFS rates.

NCPA’s state affairs team can assist your association or group with legislation. Contact for information.

  • MACPAC January Public Meeting covers streamlining Medicaid managed care authorities: The Medicaid and CHIP Payment and Access Commission Public Meeting this week included continued discussions on streamlining Medicaid managed care authorities and a vote on a draft recommendation for Congress to amend Section 1932(a)(2) to allow states to use state plan authority rather than waiver authority to require managed care enrollment of all Medicaid beneficiaries. The Commission voted 12 (yes) – 2 (abstain) – 2 (not present) in favor of the draft recommendation, which will be included in the March report. The Public Meeting also included an update on current and future MACPAC activities, with a notification that MACPAC is considering a chapter on drug pricing in their June report. NCPA will continue to monitor MACPAC recommendations and discussions for their downstream impact on independent community pharmacies.
  • NCPA Working with 24 States on 2018 Session Bills: NCPA has provided bill review services to 24 states so far in conjunction with 2018 state legislative sessions. NCPA will continue to monitor legislation introduced and provide support to our state partners on a range of issues impacting community pharmacists and their patients.