Generic Drug Payment Bill Introduced in the U.S. House of Representatives: Bipartisan legislation to increase transparency in generic drug payments in taxpayer-funded federal health programs and preserve patient access to local community pharmacies was introduced in the House this week by Reps. Doug Collins (R-Ga.) and Dave Loebsack (D-Iowa) along with six of their colleagues. H.R. 1316, the Prescription Drug Price Transparency Act, was introduced with very strong support including the chair and vice-chair of the Republican Conference and four members of the House Energy and Commerce Committee. Additional members of Congress who are original sponsors of H.R. 1316 include (in alphabetical order) Reps. Brian Babin (R-Texas), Rod Blum (R-Iowa), Buddy Carter (R-Ga.), John Duncan, Jr. (R-Tenn.), Cathy McMorris Rodgers (R-Wash.), and John Sarbanes (D-Md.). Specifically the legislation would:
- Require pharmacy benefit managers (PBMs), which serve TRICARE and the Federal Employee Health Benefits (FEHB) programs, to provide updates and disclosures to pharmacies for maximum allowable costs (MAC) lists;
- Set a standard for how frequently those lists are updated;
- Prohibit sharing patient information with PBM-owned pharmacies unless a patient has chosen to fill that prescription there, and
- Forbid PBMs from mandating patients use their affiliated pharmacies.
If your member of Congress is listed above, please go to the NCPA Legislative Action Center to send an email thanking them for their support of independent community pharmacy. If your lawmaker is not a cosponsor, ask them to sign on as one through the Legislative Action Center. Additionally, attached is NCPA’s one pager on the legislation.
Community Pharmacy Champion Rep. Doug Collins Holds Community Pharmacy Special Order: Independent community pharmacy champion Rep. Doug Collins (R-Ga.) held an hour long community pharmacy special order on the floor of the U.S. House of Representatives this week. Led by Rep. Collins, several pharmacy champions took to the House floor to denounce PBM tactics that are hurting patients and pharmacies. Collins was joined by Reps. Brian Babin (R-Tex.), Buddy Carter (R-Ga.), John Duncan (R-Tenn.), Dave Loebsack (D-Iowa), and Austin Scott (R-Ga.). In addition, Rep. Pete Sessions (R-Tex.) submitted a statement (see attached), and Rep. Cathy McMorris Rodgers (R-Wash.) was among the lawmakers who tweeted their support. NCPA was also pleased that NCPA’s Infographic explaining DIR fees was used during the special order. https://www.c-span.org/video/?c4659181/community-pharmacy-floor-speeches
NCPA Requests Committees of Jurisdiction Take Action on DIR Legislation: CEO Doug Hoey wrote to all members of the House Energy and Commerce, Ways and Means, and Senate Finance Committees detailing NCPA’s support for the bipartisan House and Senate bills and asking those committees to schedule legislative hearings on H.R. 1038 and S. 413.
NCPA Comments on 2018 CMS Draft Call Letter: The Call Letter provides updates to the Medicare Advantage (MA) and Medicare Part D programs. Policy changes identified in the proposal impacting independent pharmacy include star rating changes, drug utilization review control changes to avoid over use of opioids, tiered formulary changes and more clarity surrounding access to preferred cost-sharing pharmacies (PCSPs). NCPA’s comments focused on the following:
- Access to Preferred Cost-Sharing Pharmacies- NCPA would recommend that that there be consequences for those plans that have been identified as “outliers” for consecutive plan years. For example, if a plan is identified as an “outlier” for two plan years in a row, that plan should be prohibited from advertising that they offer “preferred cost sharing”. In addition, Medicare Part D Plan Sponsors Using a Preferred Network Should Incur a Financial Penalty or Other Sanction in the Event that Drugs are More Expensive at Preferred Pharmacies than Non-Preferred Pharmacies After Considering DIR.
- Specialty Tiers – For 2018, CMS proposes to maintain the specialty tier threshold established at $670 for the 2017 plan year. NCPA encourages CMS to continue investigating whether the inclusion of Part D drugs on a specialty tier adversely affects drug utilization or enrollment decisions by certain types of beneficiaries, and the impact of tiering exceptions for specialty tier drugs. Also NCPA reiterated our support for current Part D policy that Part D plans may not restrict access based solely on the placement of a Part D drug in a “specialty/high cost” tier because this tier placement alone is not indicative of any special requirements associated with such drug.
- Forecasting to 2019 and Beyond: Potential New Measures for 2019 and Beyond – NCPA reiterated to CMS that many large Part D plans already have contractual requirements in place using existing PQA measures, that were developed for use at the health plan level, to measure quality at the pharmacy level. The implications for our members based on these requirements are great and we are urging both PQA and CMS to further assess the reliability of existing PQA measures at the pharmacy level. There are many outstanding questions in the methods that are currently or will be used in the future to determine reliability.
Sen. Brown Submits DIR Fees Question as part of Senate Finance Committee Confirmation Hearing for CMS Nominee: Ms. Seema Verma, President Trump’s nominee to lead CMS testified last month before the Senate Finance Committee. At NCPA’s request, independent pharmacy champion Sen. Sherrod Brown (D-OH) submitted a question on DIR fees and pending CMS guidance for the record and Ms. Verma has subsequently provided an answer.
- Question: Will you commit to supporting the finalization of such guidance? What role do you believe retroactive DIR fees have on exacerbating closures and consolidation across the delivery system? What specific steps would you take to improve transparency between plans and pharmacies in the use of DIR fees in the Medicare program?
- Answer: If confirmed, I will welcome the opportunity to work with Congress and all stakeholders, including small community pharmacies and long-term care pharmacies, to preserve seniors’ access to drugs. Additionally, I look forward to working with you to consider how to resolve this pending guidance issue. I would be happy to discuss the September 2014 Proposed Guidance on Direct and Indirect Remuneration and Pharmacy Price Concessions and other related issues with you.
On a related note, the Senate Finance Committee voted this week to advance the nomination of Ms. Verma to be Administrator of CMS by a vote of 13 to 12 along party lines. It was the committee’s second vote on Verma, after a tie earlier in the week. Verma is the founder and chief executive officer of SVC Inc., an Indiana-based health policy consulting firm. She worked with then-Gov. Mike Pence, who’s now vice president, to design Indiana’s Medicaid program, which requires beneficiaries to contribute to health savings accounts, and has helped other states design Medicaid expansion waiver programs. Verma’s Senate confirmation vote has yet to be scheduled.
Trump’s Address to Congress: President Donald Trump made his first joint address to Congress this week and though he didn’t provide many specifics on health care he did promise to tackle drug pricing as part of ACA repeal efforts and laid out several of his principles for health reform:
- New tax credits to help individuals purchase coverage;
- Expanded use of health savings accounts;
- Greater state flexibility for Medicaid;
- Allowing insurers to sell health plans across state lines, and
- Keeping the popular ACA provision that prohibits insurers from discriminating against individuals with expensive medical conditions.
Eye on PBMs: The video and articles linked below help explain some of the confusing and opaque PBM practices:
- The 11Alive Investigators—Side Effects: The Middlemen
- The 11Alive Investigators—Side Effects: The Middlemen Part 2
- Drug Benefit Managers Need More Oversight, Pharmacists Say
- You’re Overpaying for Drugs and Your Pharmacist Can’t Tell You
NCPA Submits Letter to FDA Requesting Guidance on Dispenser-to-Dispenser Transfers: On March 3, NCPA jointly submitted a letter with the American Pharmacists Association and MatchRx to FDA requesting guidance on dispenser-to-dispenser transfers per the ‘specific patient need provision’ in the Drug Supply Chain Security Act (DSCSA), which allows the transfer of drug products between dispensers to fill a prescription for an identified patient. NCPA and other industry partners have requested similar guidance in the past, but the issue has taken on new significance as some states are getting ahead of overdue federal guidance regarding wholesale distributor licensure provisions of the DSCSA by developing their own licensure requirements. Varied licensure approaches by these states are inconsistent with the DSCSA’s goal to implement national standards for prescription drug wholesale distributors.
FDA has signaled its view that dispenser-to-dispenser transfers qualify as filling a “specific patient need” under the DSCSA and do not constitute wholesale distribution and consequently are not subject to obtaining a wholesale distributor license. NCPA is encouraging FDA to formally clarify its position and the types of transfers dispensers can make without a wholesale distribution license to avoid disruptions in needed drug supplies for specific patient needs.
Tell Lawmakers on Capitol Hill to Put an End to PBM Abuses: If you’re not sitting at the table, you could be on the menu. Don’t be the PBMs’ dinner! Come to Washington April 26-27 for the NCPA Congressional Pharmacy Fly-In and tell your elected officials in person why Congress needs to rein in PBMs’ abusive practices and support generic drug pricing transparency. In-person meetings are the most compelling way to make our message heard on Capitol Hill, so 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 and fight for community pharmacy. All it takes is one day and your voice.
In the States:
- Nevada: NCPA State Government Affairs submitted a letter in opposition to S.B. 171. This bill would require retail community pharmacies to provide a means for persons to dispose of unused drugs including opioids and other drugs that were not dispensed by the pharmacy.
- Florida: NCPA State Government Affairs submitted a letter in support of S.B. 670 which would ensure that a pharmacy is not excluded from the Medicaid Managed Care Plan Network if it meets credentialing requirements, and ensures that a pharmacy is reimbursed at the same rate as all pharmacies within the managed care plan network. NCPA also submitted comments regarding the structure of the state’s Medicaid Managed Care Pharmacy Networks including the importance of adequate provider reimbursement and beneficiary access.
- Massachusetts: H.B. 537 was introduced and would allow for greater transparency in Maximum Allowable Cost pricing.