ACA Repeal Marked up in the House Committees of Jurisdiction: The House Energy and Commerce and Ways and Means Committees marked up their respective instructions to the Budget Committee on party line votes after exhaustive sessions in both committees this week. The House Energy and Commerce Committee voted to repeal and replace provisions of the Affordable Care Act (ACA) within the Committee’s jurisdiction, including repealing the ACA Medicaid expansion, shifting Medicaid to a per capita-based funding approach, providing safety net funding for states that did not expand Medicaid, repealing certain ACA provisions including the cost-sharing subsidy, establishing funding for a Patient and State Stability Fund, and establishing a penalty for failure to maintain continuous health insurance coverage. The House Ways and Means Committee voted to repeal the deduction limit on remuneration from health insurance providers; repeal the indoor tanning tax; repeal the ACA annual fee on brand drug manufacturers, importers, and health insurers; repeal the net investment income tax; and repeal and replace the ACA’s health-tax related policy. The House Budget Committee is scheduled to consider these recommendations next week and then assemble them into an Omnibus Package for the Senate to consider. Best case scenario for the GOP Congress and Administration would be to have the repeal completed by the Easter Break but that ambitious deadline could certainly slip. Please find attached a summary of the American Health Care Act, prepared by NCPA for members.
Pharmacy Caucus Co-Chair Peter Welch and Ranking Member Elijah Cummings meet with President Trump to Talk about Soaring Prescription Drug Costs: This week House Oversight and Government Reform Committee Ranking Member Elijah Cummings (D-Md.) and Rep. Peter Welch (D-Vt.), met with President Donald Trump on drug prices. Rep. Welch is also the lead on the DIR Fee legislation (H.R. 1038) which would prohibit PBMs from retroactively reducing fees to pharmacies who have submitted clean claims. At the meeting they discussed legislation they plan to introduce to require the Secretary of Health and Human Services (HHS) to negotiate drug prices in Medicare Part D. Other provisions of the legislation include those to: direct the Secretary of HHS to establish a formulary to leverage the purchasing power of the government on behalf of Part D plans; allow Part D plans to use additional benefit design and formulary tools to secure higher discounts or rebates; establish a fallback process if negotiations with drug manufacturers are unsuccessful; require the inclusion of at least one drug to treat each clinical condition, as identified by the Secretary; and preserve patient appeals processes for non-formulary drugs. NCPA provided materials to Cummings and Welch prior to the meeting outlining community pharmacy perspective on the issue. They also issued a press statement, which includes a draft of the bill.
Bill Recognizing Pharmacists as Health Care Providers Continues to Gain Momentum: S. 109/H.R. 592, the Pharmacy and Medically Underserved Areas Enhancement Act continues to gain sponsors. The bill recognizes pharmacists as health care providers and permits state-licensed pharmacists in medically underserved communities to both provide and be reimbursed for an expanded scope of patient-care services under the Medicare Part B program. S. 109 has garnered 32 cosponsors in the Senate and H.R. 592 currently has 138 cosponsors. NCPA is a part of the Patient Access to Pharmacists’ Care Coalition (PAPCC)—a group of more than 35 national and 70 state organizations representing patients, pharmacists, and pharmacies, as well as other interested stakeholders—dedicated to ensuring the full capabilities of pharmacists are recognized and compensated.
Consumer Interest Organization White Paper Places Further Scrutiny on PBMs: The week, the American Consumer Institute published a new educational ConsumerGram on Pharmacy Benefit Managers (PBMs) and how their market influence and lack of transparency can influence consumer drug pricing. PBMs are virtually unregulated in what is an otherwise regulated health care sector. The ACI analysis of the PBM market included a review of the industry structure, conduct and performance, and their findings include a host of problems (market failures and market power). ACI concluded that PBMs are major drivers in higher prescription prices for consumers and they propose a number of remedies to increase transparency, heighten competition and increase consumer choice. Please find the white paper attached.
Seema Verma Moves Closer to Confirmation as CMS Administrator: Last week the Senate voted 54-44 to invoke cloture on the nomination of Ms. Verma to head the agency and is slated for a final vote on March 13th , where she will likely be approved to run the large federal agency that oversees ACA and two massive entitlement programs. As an Indiana-based health consultant, Verma gained national recognition by working with GOP states to add conservative elements to their Obamacare Medicaid expansion programs. Verma worked for then-Gov. Mike Pence when he accepted that major piece of Obamacare. If confirmed as CMS administrator, Verma would also oversee efforts to work with states on revamping their Medicaid programs, as well as major changes to Medicare payment policy under MACRA, a 2015 law that was passed with strong bipartisan support.
Affordable Care Act Overhaul? Political Uncertainty? Intense Scrutiny on PBMs?: Yep, it’s exactly the right time for you to come to D.C. and stand up for community pharmacy. The NCPA Congressional Pharmacy Fly-In April 26-27 is your once-a-year opportunity to come to Washington and educate your elected officials in person about PBMs’ abusive practices and urge them to stand up for community pharmacy as Congress overhauls the Affordable Care Act. We’ve made the event much shorter and more affordable this year so you can come to Washington and meet with decision-makers. Due to the new format of this year’s meeting, the Hilton Alexandria will serve as the anchor hotel, but we do not have a room block in order to give you more flexibility to choose a hotel that suits your needs (find a list of hotel options on the NCPA website). Register now online or by calling 1-800-544-7447. Legislative advocacy is what NCPA does best, but we can’t protect your practice without YOU.
In the States:
- West Virginia: S.B. 522 was introduced and includes provisions that would require fair pharmacy audit protections against PBMs. The bill would also require PBMs register with the Insurance Commissioner in order to conduct business in the state.
- New York: The National Community Pharmacists Association (NCPA) submitted letters in support of A. 3007 and S. 2007 Section J, which requires PBMs to register and obtain a license in order to conduct business in the state.
- New York: A. 2763 was introduced and includes provisions that would require fair pharmacy audit protections against PBMs. The bill addresses both in-store and remote audits.