NCPA Advocacy Center Update – Week Ending June 30, 2017

MAC Update Amendment Included in House Defense Authorization Bill:  Congressman Austin Scott (R-GA) successfully added an amendment to the defense authorization bill to ensure that MAC lists are regularly updated in the TRICARE retail pharmacy program.  This is a big step towards more transparency in the TMOP program and ensuring that taxpayer dollars are being spent wisely. NCPA supported this effort and will stay engaged on it. Additionally there was an amendment offered to extend the TRICARE retail pharmacy pilot for another year in the authorization bill.

Senate Delays Consideration of GOP Health Care BillRepublican leaders postponed consideration of their repeal of the Affordable Care Act, dubbed the Better Care Reconciliation Act. They aim to change the legislation and get a new estimate from the Congressional Budget Office in hopes of securing the necessary votes in order to proceed on the bill in July.  Advocacy staff has been and will remain in consistent communication with the Hill on the value of community pharmacists to patients across the country, the important role pharmacists play in serving Medicaid recipients, and the critical need to ensure access to prescription drugs and pharmacy services.

Senate Letter on Retail Pharmacy Pilot Garners Tremendous Support:  A letter led by Senators Tom Cotton (R-AR) and Gary Peters (D-MI) was sent earlier this week to Secretary James Mattis encouraging his agency to enact the pharmacy pilot program that was included in the 2017 NDAA.   The pilot program allows the Department of Defense (DoD) to access lower pricing for prescriptions dispensed at retail pharmacies. If authorized by the Secretary, 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. The letter was also signed by Senators James Inhofe (R-OK), Johnny Isakson (R-GA), Marco Rubio (R-FL), Thom Tillis (R-NC), Bill Cassidy (R-LA), Jerry Moran (R-KS), Pat Roberts (R-KS), John Kennedy (R-LA), Mike Rounds (R-SD), John Cornyn (R-TX), Debbie Stabenow (D-MI), Shelley Moore Capito (R-WV), Luther Strange (R-AL), Heidi Heitkamp (D-ND), Jon Tester (D-MT), Dean Heller (R-NV), Rob Portman (R-OH), Robert Menendez (D-NJ), and Robert Casey (D-PA).

Invite Your Legislators to Visit Your Pharmacy:  Congress has an in district work period scheduled for July 1-10 followed by a month-long one in August, making this an ideal time to invite your lawmakers for a pharmacy tour and discussion of legislation vital to you and your patients. These tours are an effective way to make a lasting personal impression on your legislators by demonstrating the role you play in the community and health care system. Tips for scheduling a pharmacy visit with your members of Congress can be found here. Click here for a sample invitation you can customize, or you can contact Michael Rule at (703) 838-2671 or for more information. 

NCPA Asks OMB Director to Focus on PBMs’ Role in High Prescription Drug Prices:  As the Trump Administration considers steps to tackle rising prescription drug costs, the U.S. Office of Management and Budget has emerged as a key player. NCPA sent a letter to OMB Director Mick Mulvaney to request a meeting and offer recommendations, such as addressing controversial PBM business practices:

  • Fix unpredictable retroactive pharmacy DIR fees that cause Medicare beneficiaries and taxpayers to pay more for prescription drugs.
  • Push for policies promoting pharmacy competition and patient choice that are being undermined by the conflicts of interest associated with PBMs’ ownership of mail order and specialty pharmacies.
  • Address the lack of transparency and added cost resulting from PBMs providing preferential treatment on their formularies that determine which prescription drugs get dispensed because of drug manufacturer rebate deals.

Advocacy Staff Attends Drug Pricing RoundtableNCPA staff represented you at a recent roundtable that Congressman Morgan Griffith (R-VA) hosted in the greater Bristol area.  The co-owner and head pharmacist from Falcon Pharmacy in Abingdon were featured panelists.  Also in attendance were three members of the Virginia House of Delegates, health systems pharmacists, Virginia AARP and local hospital administrators.  The discussion focused on the soaring price of prescription drugs and Congressman Griffith spoke about his concerns about the lack of transparency in the large PBM industry and his legislation that would ban retroactive DIR fees.

Pharmacy Owners: Don’t Be Left Out of the Community Pharmacy Census:  NCPA has put together its fourth census to document who you are and what you do. This is your chance to be a part of the bigger story we communicate to legislators, regulators, the media, and patients.  Data from the pharmacy profiles will help NCPA bring new opportunities to community pharmacies. It is critical that as many community pharmacies as possible complete the census.  There are no financial questions and there is no need to reference other documents for answers.  You can take the census on your mobile phone, tablet, or desktop computer in just 8-9 minutes.  It’s easy to support community pharmacy – take just a few minutes today to share your story with us. 

In the States:  

  • New Jersey: A 5041 was introduced and would prohibit a PBM from retroactively reducing payment on a properly filed claim for payment by a pharmacy. Specifically, the bill provides that, after the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly, through aggregated effective rate or otherwise, except if the claim is found not to be clean during the course of a routine audit. Nothing in the bill prohibits any retroactive increase in payment to a pharmacy pursuant to a written agreement between the PBM and the pharmacy.