Senate Releases Its Version of ACA Repeal Bill: This bill retains the protections on pre-existing conditions and insurers would still be required to accept all consumers. However, this legislation would allow states to waive compliance with other rules that stipulate that insurers must cover essential health benefits (one of which is prescription drugs). On the Medicaid front, starting in 2020, states could choose between receiving a block grant or a set amount per number and type of enrollees—otherwise referred to as a per-capita cap. Those states that expanded their Medicaid programs under the ACA received increased funding to do so. Starting in 2021 those enhanced payments would be rolled back to traditional Medicaid funding rates. The individual mandate would be eliminated as would the requirement that midsize and large companies provide coverage to workers. This bill would extend the ACA’s cost-sharing subsidies for two years—that currently help insurers cover costs for low-income customers. This bill would eventually repeal many of the ACA-related tax provisions including the surtax on higher earners investment income and a Medicare Hospital Insurance surtax on the rich. It would also repeal several industry taxes, including those on medical devices and health insurers. NCPA will continue to fight to ensure key pharmacy provisions are retained.
Urge Senators to Voice Support for TRICARE Pharmacy Pilot: The fiscal year 2017 National Defense Authorization Act (NDAA) authorized Secretary of Defense James Mattis to implement a pilot program to allow the Department of Defense to access lower pricing for prescriptions dispensed at retail pharmacies. If authorized, this pilot would reduce prescription costs for the DoD, expand TRICARE beneficiary choice and access to prescription drugs at retail pharmacies, and streamline DOD administrative and prescription drug rebate processes. Please contact your senators and ask him or her to sign on to a bipartisan letter led by Sens. Tom Cotton (R-Ark.) and Gary Peters (D-Mich.) to Mattis, urging him to utilize his authority to authorize this prescription drug pilot program. In addition to Sens. Cotton and Peters the following Senators have signed on: Cassidy (R-La.), Inhofe (R-Ok.), Isakson (R-Ga.), Moran (R-Ks.), Rubio (R-Fl.), Stabenow (D-Mich.) and Tillis (R-N.C.).The deadline for senators to sign-on is Monday, June 26.
Final Medicare Part D DIR Reporting Requirements for 2016 Released by CMS: The final CMS guidance relates to how Part D plan sponsors report direct and indirect remuneration (DIR). While the guidance will not change existing policy with regard to DIR fees, it does require plans to provide greater granularity to CMS on DIR amounts and the types of arrangements they put into place. CMS has responded positively to NCPA’s recommendations over time, and this guidance does again increase the level of detail that sponsors must report regarding pharmacy price concessions. CMS does make clear that the purpose of this document, including the changes to DIR #8 and DIR #9, is not to define what pharmacy price concessions can or cannot be reasonably determined at the point-of-sale. Rather, the purpose is to provide Part D sponsors guidance on how to report DIR, such as pharmacy price concessions that were not included in the negotiated price, for the 2016 contract year. NCPA remains committed to ending retroactive pharmacy DIR fees by passing S. 413 / H.R. 1038, the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act,” however, we’re also committed to working with CMS to provide clarity on DIR fees as they currently exist via the regulatory process.
Lawmakers Press PhRMA, AHIP and PCMA on Rising Insulin Prices: Reps. Diana DeGette (D-Colo.) and Tom Reed (R-N.Y) who co-chair the Congressional Diabetes Caucus sent letters this week to the heads of the drug, insurance and pharmacy benefits manager lobbies requesting a meeting to discuss the increasing cost of insulin and policy solutions to bring the price down before the end of July. NCPA supported their efforts and provided both members with information regarding patient and independent pharmacy concerns.
NCPA, APA File Brief in Federal Appeals Court in PBMs’ Case Against Arkansas Drug Pricing Transparency Law: NCPA and the Arkansas Pharmacists Association (APA) have filed an amici curiae brief in the United States Court of Appeals for the Eighth Circuit in support of the state of Arkansas and against a challenge by the Pharmaceutical Care Management Association (PCMA) to Act 900, passed by the Arkansas General Assembly in 2015. The ongoing legal battle has prevented Arkansas from implementing a more transparent system under which pharmacy benefit managers (PBMs) determine generic prescription drug reimbursements to pharmacies. PCMA’s ongoing contention that Act 900 is preempted by the Medicare Modernization Act (MMA) and the Employee Retirement Income Security Act (ERISA) is flawed. We believe they have not cleared the high bar that allows federal law to override state laws. In our filing we argue for the Court of Appeals to ‘affirm the portion of the District Court’s judgment finding no preemption under the MMA, reverse the portion of the judgment finding preemption under ERISA, and remand with directions for the District Court to enter judgment in favor of the Attorney General on all claims.’ In other words, allow the law to stand as originally intended by the elected officials in Arkansas.
