GOP Health Care Overhaul Stalls Indefinitely: The Senate rejected several proposals to repeal and/or replace the ACA, including a final attempt at a “skinny” repeal primarily targeted at the individual and employer insurance mandates. The votes likely end the remarkable, closed-door, party-line effort as Senate Majority Leader Mitch McConnell declared afterward it is “time to move on.” This potentially clears the way for action on other issues, particularly those with bipartisan support. Of note to community pharmacy, during the Senate floor debate on the repeal/replace bill, Sen. Wyden’s floor speech covered the need to pursue a bi-partisan approach to fixing ACA, specifically going after the PBMs and promoting his C-THRU legislation as a tool to protect consumers and control drug costs. Here is a link to his speech (comments on prescription drugs start at about the 20:10 mark). https://www.youtube.com/watch?v=hMVFi21RQ-Y
NCPA has and will continue to engage lawmakers on the importance of preserving access to prescription medication and pharmacy services. Senate Republicans’ years-long push to repeal the ACA is stalled for now and could possibly put the short-term focus back on HHS and the Trump administration, which again face looming decisions about the fate of the ACA markets.
House Ways & Means Committee Announces Initiative to Reduce Legislative & Regulatory Burdens for Medicare Providers: This week Ways and Means Health Subcommittee Chairman Pat Tiberi (R-Ohio) announced a new initiative that aims “to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries.” The Ways and Means Committee seeks to work with a range of providers to reduce legislative and regulatory burdens under the current Medicare program. The initiative will consist of a three step process that will involve (1) obtaining feedback from stakeholders regarding current legislative and regulatory burdens; (2) hosting stakeholder roundtables; and (3) taking Congressional action in response to stakeholder feedback. NCPA will be submitting feedback to the committee outlining independent community pharmacy perspectives in regard to this initiative.
NCPA Rebuts Misleading PBM Research Paper On DIR Fees: The Pharmaceutical Care Management Association’s (PCMA) research paper suggesting that accounting for fees on pharmacies at the point-of-sale would increase Medicare costs is based on dubious assumptions. NCPA believes this is just another in a long line of studies the PBM trade group has cobbled together to try to validate their practice of charging pharmacies unpredictable after-the-transaction DIR fees. These fees not only hinder independent pharmacies’ ability to know whether or not they’ll break-even on a transaction, but they also can push Medicare patients more quickly into the Medicare donut hole. This also pushes patients into the catastrophic phase of coverage where the government takes on the lion’s share of the costs. Here are shortcomings of the report:
- The report fails to account for the federal savings that the federal government would realize by eliminating retroactive DIR—particularly by lowering the amount Medicare spends on low-income cost sharing (LICS) and federal reinsurance spending.
- The report neglects to clearly state the considerable patient benefits inherent in eliminating retroactive DIR. Patients would realize lower out-of-pocket costs at the pharmacy counter. Current post-point of sale DIR arrangements only favor beneficiaries who enroll in Part D plans without using them.
- The focus of PCMA’s “study” is the effect of eliminating all manufacturer rebates and pharmacy price concessions—as opposed to simply applying those amounts at the point of sale. When applied at point of sale—which is exactly what the NCPA-supported legislation would do—savings would be provided not only to the federal government but also consumers/ taxpayers.
- This report also reveals that “PDPs and their PBMs also negotiate significant POS price concessions with their network pharmacies typically in the form of a percentage discount off a known price benchmark such as the wholesale acquisition cost (WAC). Unlike post-POS price concessions, these discounts can be determined at the time a prescription is dispensed. At the present time, PDPs and their PBMs are indeed deducting these amounts from pharmacy reimbursement but NOT at the point of sale. PDPs and their PBMs are clawing back these amounts from pharmacy after the point of sale and presumably reporting these amounts as DIR in direct violation of federal guidance.
Here is the report: https://www.pcmanet.org/value-of-direct-and-indirect-remuneration-dir-impact-on-medicare-part-d-prescription-drug-plan-pdp-program-stakeholders/
Update on Reform of Requirements for Long-Term Care Facilities: As previously reported in the NCPA LTC Newsletter, Phase 1 of a final rule making major changes to improve the quality of care and safety of nursing home residents became effective on Nov. 28, 2016. Also referred to as the “Mega Rule,” the final rule revises the requirements that LTC facilities must meet in order to participate in Medicare and Medicaid programs. This rule has not had a comprehensive rewrite for nearly 25 years. Of importance to LTC pharmacies, Phase 2 goes into effect Nov. 28, 2017, and includes new requirements for medical record reviews, psychotropic drugs, infection control, and antibiotic stewardship, to name a few. This link from CMS provides important information. For further information, consider attending ASCP’s Aug. 10 webinar listed below. NCPA is working with ASCP to offer NCPA LTC members free access to this important webinar.
Mark Your Calendars for Aug. 9 & 10—Back-to-Back CE Webinar Opportunities Relevant to Your LTC Business: Two days. Two webinars. Two hours of live CE. The NCPA LTC Division is offering NCPA LTC members two opportunities for live CE back-to-back Aug. 9 & 10.
Wednesday, Aug. 9, 2 p.m. ET
Opportunities for Growth—Building a Business with Long-Term Care, brought to you by the NCPA Innovation Center, gives you all of the pieces you’ll need for a solid foundation to create and grow your LTC business.
Registration: Free and open to all pharmacists and pharmacy technicians.
Thursday, Aug. 10, 1 p.m. ET
From Antibiotics to Reconciliation and Everything In-Between: An Initial Look at Phase 2 Revised Guidance to Surveyors, brought to you by the American Society of Consultant Pharmacists (ASCP), will clarify CMS’ Phase 2 Interpretative Guidelines and will help answer your questions about implementing the changes contained in the LTC “Mega Rule.”
Advance registration is required.
Registration: Free for NCPA LTC members ($99 regular price). Use promo code IGPROMO at checkout after making an ASCP guest profile.
MONDAY: LAST CHANCE to Save on Convention Registration: This is your last chance to claim the biggest savings of the year on your registration to the NCPA 2017 Annual Convention Oct. 14-18 in Orlando, Fla. Don’t miss out on 30+ educational programs covering all dimensions of your pharmacy business, hundreds of industry partners showcasing their latest products, services, and technology (and many offering show discounts), countless opportunities to share with your peers, and walk-away plans with solutions. Claim your special $150 discount off of on-site registration rates by 11:59 p.m. July 31. Visit the NCPA website or call 1-800-544-7447 to register.
Don’t Be Left Out of the Community Pharmacy Census – Deadline Aug. 4: Interested in helping consumers find your pharmacy, learn about what services you offer and become customers? Of course you are. NCPA can help you with that, but first, we need you to help us. Your responses to NCPA’s Community Pharmacy Impact Census helps us document who you are and what you do. By completing the survey, you share info about your specific pharmacy and practice that NCPA uses to bring new opportunities to your pharmacy and information to policymakers and the media. Take the census in just 8 minutes on any device by Aug. 4.
