NCPA Advocacy Center Update – Week Ending March 25, 2017

Come Give Congress a Piece of Your Mind at the Congressional Pharmacy Fly-In April 26-27:  We are filling the halls of Congress April 26-27 with independent community pharmacies who are passionate about their patients and their practice and are tired of the tyranny of PBMs.  Join your colleagues as we take on Capitol Hill during the NCPA Congressional Pharmacy Fly-In to educate elected officials in person about PBMs’ abusive practices and urge them to stand up for community pharmacy.  Join our fight to:

  • Ban retroactive DIR fees — Pharmacy’s #1 Most Wanted is in the cross hairs of new bipartisan legislation. We’re gaining new allies and momentum every day.
  • Attack the MACs — Force PBMs to be more transparent and update MACs to reflect real-world costs.
  • Preserve your access to patients — Fight cuts to pharmacy reimbursement and restrictions like mandatory mail order. And more!

We’ve made the event much shorter and more affordable this year so you can come to Washington and meet with decision-makers. 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.

AHCA Bill Pulled from House Floor: The American Health Care Act (AHCA), which would have initiated the repeal and replacement of the Affordable Care Act (ACA) was pulled shortly before a scheduled floor vote on Friday in a blow to President Donald Trump and House Speaker Paul Ryan (R-Wi.).  The move came amid late-breaking defections by moderates who argued that its curbs on Medicaid could harm vulnerable constituents and far-right members of the Republican conference contended that it failed to do away with the ACA’s core components.  The move comes after seven years of Republican pledges to uproot the 2010 health law.  The House will be back in session next week and NCPA will be closely monitoring any developments.  We’ll continue to work constructively with Congress and the Trump Administration to ensure that patient access to prescription drug services is maintained and that pharmacies are reimbursed fairly for helping patients achieve better health outcomes.

116 Organizations Join NCPA in Thanking Members of Congress for Sponsoring DIR Legislation:  Attached are copies of the House and Senate versions of a thank you letter to the sponsor and original cosponsors of H.R. 1038/S. 413, with all 117 signatories listed. Not only is this total significantly higher than September’s letter endorsing the legislation in the last Congress, but the array of signatories represents a broader spectrum of the health care industry demonstrating that the effects of retroactive DIR fees are widespread. Given the focus on the healthcare debate in the House, we plan to send this to all Hill offices next week with a press release following shortly after.

NCPA Commissioned Report Discusses Impacts of Medicare Part D DIR:  NCPA commissioned a nationally recognized actuarial consulting firm with extensive expertise in health care and health care reform to prepare a report on the Impacts of DIR Under Medicare Part D.  The findings of this report reiterate and bolster the findings of the CMS Fact Sheet on DIR released in January 2017.  This report goes above and beyond some of the other DIR white papers that have been commissioned by other organizations because of the fact that it is authored by an actuarial firm with extensive knowledge of the inner workings of and money flows in Medicare Part D.  NCPA believes that this actuarial  report will ultimately be invaluable in our advocacy work with federal regulators and Congressional members. Under the terms of our contract with this actuarial group, NCPA is authorized to share this document with NCPA members, members of Congress and their staff, CMS and MedPAC.  To date, NCPA has provided this document to CMS, MedPAC and some of our selected Hill champions.  Due to the fact that the actuarial firm client list includes a significant number of Part D sponsors and that a significant portion of their business consists of  preparing Part D bid submissions for these sponsors, they were very firm on these NCPA distribution restrictions.  For these reasons, NCPA has not issued any public press statements on the existence and findings of this white paper.  NCPA felt that the benefits of having this study conducted by such a reputable third party far outweighed any concerns we may have had regarding the restrictions.  If you have additional questions about this report or any of the findings therein, please contact Susan Pilch, VP of Policy and Regulatory Affairs at susan.pilch@ncpanet.org or at (703) 838-2669.

Pharmacist Statewide Protocols Resource Now Available:   The National Alliance of State Pharmacy Associations and the National Association of Boards of Pharmacy have developed policy recommendations for pharmacist statewide protocols, a framework that specifies the conditions under which pharmacists are authorized to prescribe a specified medication or category of medications when providing a clinical service. These recommendations, which NCPA helped create,  include the key elements that should be included in state laws and regulations authorizing the development of statewide protocols.

NCPA in the News:  NCPA urged Congress to pass MAC legislation (H.R. 1316) to shine more light on prescription drug costs, in an article published on leading Capitol Hill website The Hill.com – http://thehill.com/blogs/pundits-blog/healthcare/325609-maximum-allowable-cost-reimbursements-under-federal-healthcare

HRSA Delays Effective Date of 340B Final Rule on Ceiling Prices and Civil Monetary Penalties:  On March 20, 2017, the Health Resources and Services Administration (HRSA) published an interim final rule delaying the effective date of the 340B Ceiling Price and Civil Monetary Penalties (CMP) rule until May 22. HRSA also asked for comments on whether the effective date of the rule should be delayed further, until October 1. The Final Rule established civil monetary penalties for manufacturers that knowingly and intentionally charge covered entities more than the ceiling price for a covered outpatient drug, and requirements for refunding covered entities in connection with truing up estimated ceiling prices and revised ceiling prices resulting from routine restatements of CMS Medicaid data. The delay in the effective date also delays the enforcement of the Final Rule. The IFR states that “enforcement will be correspondingly delayed” but does not address whether enforcement will again be delayed until the first day of the next calendar quarter.

MedPAC Recommends Payment Cuts to Home Health Agencies and Inpatient Rehab Facilities, Freezes for LTC Hospitals and SNF’s:   The Medicare Payment Advisory Commission submitted its report to Congress on March 15, which includes a recommendation for 5 percent payment cuts to home health agencies and inpatient rehabilitation facilities. The report also recommends no increases next year for long-term care hospitals, hospices, ambulatory surgical centers and skilled nursing facilities, in addition to freezing skilled nursing facility payment rates for two years while the payment system is revised. MedPAC said that payment changes would ideally bring all types of post-acute care into a unified payment system. Implementing its recommendations would reduce fee-for-service program spending by over $30 billion over the next 10 years, the report said. MedPAC’s recommendations are not law.  Congress must adopt MedPAC’s recommendations in order for them to be fully implemented, so it’s not clear that these policy recommendations will ever be enacted.

In the States: 

  • New Mexico: H.B. 122 was signed into law on March 17th. It would  prevent a PBM from charging a pharmacist or pharmacy a transaction fee related to the adjudication of a claim. We want to congratulate the New Mexico Pharmacy Business Council, the New Mexico Pharmacists Association and all the community pharmacists involved on their hard work and success.
Posted in Legislation



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