CMS Releases Annual Part D Plan Sponsor DIR Reporting Guidance Including Details on Reporting Pharmacy DIR: This week CMS released a memo proposing guidance for Part D sponsors on reporting DIR data for CY 2016. Part D sponsors are required to report DIR data at the plan benefit package level (“summary level”) on the Summary DIR Report. CMS is modifying how pharmacy DIR is collected in the Summary DIR Report. Under the new collection format, Part D sponsors must report price concessions received from pharmacies and incentive payments paid to pharmacies separately in order to better allow CMS to verify the accuracy of the data reported. Moreover, only amounts that could not be reasonably determined at the point-of-sale may now be reported as DIR. CMS will accept comments on this proposed guidance through June 2, 2017. NCPA will be commenting and continuing to stress that all pharmacy prices concessions can and should be determined at the point of sale and not reported as DIR after the fact.
NCPA Meets with CMS Administrator Verma to Discuss Pharmacist Provider Status: This week NCPA attended a meeting with the new CMS Administrator to discuss the importance of pharmacist provider status along with other members of the Patient Access to Pharmacists’ Care Coalition (PAPCC) steering committee. We had the opportunity to discuss the importance of patient access to rural pharmacy services, where oftentimes an independent pharmacy is the sole provider in the community. We are pleased that the Administrator recognizes the importance of access points to care and supports the concept of Medicare Part B pharmacist provider status. NCPA will continue to work with PAPCC members to urge passage of H.R. 592/S. 109.
NCPA President Meets with Independent Pharmacy Champions on Capitol Hill: This week NCPA President DeAnn Mullins, Pharmacist, CDE and owner of Mullins Pharmacy in Lynn Haven, FL took to Capitol Hill to meet and thank several federal legislators that are championing independent community pharmacy issues on behalf of the industry. Mullins met with following:
- Senator Shelley Moore Capito (R-Wv.) who is an original sponsor of S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR), original sponsor of S. 1044, Ensuring Seniors Access to Local Pharmacies Act (Preferred Networks/AWP), and original cosponsor of S. 109, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status). Additionally Mullins spoke to the Senator about the opioid abuse crisis and pharmacists willingness to help with solutions to help address the problem.
- Meeting with Senator Chuck Grassley (R-Ia.) staffer and pharmacy fellow Mary Abdelmalak, PharmD to thank the Senator for being an original sponsor of S. 109, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status) and an original cosponsor of S. 413, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR).
- Congresswoman Jaime Herrera Beutler (R-Wa.) who had been a past cosponsor of all NCPA priority legislation and vowed to sign on as cosponsor to H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR), H.R. 1316, Prescription Drug Price Transparency Act (MAC), H.R. 1939, Ensuring Seniors Access to Local Pharmacies Act (Preferred Networks/AWP) and H.R. 592, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status).
- Congressman Doug Collins (R-Ga.) who is an original sponsor of H.R. 1316, Prescription Drug Price Transparency Act (MAC), original cosponsor of H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR) and an original cosponsor of H.R. 592, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status).
- Congressman Morgan Griffith (R-Va.) who is an original sponsor of H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR), original sponsor of H.R. 1939, Ensuring Seniors Access to Local Pharmacies Act (Preferred Networks/AWP), and current cosponsor of H.R. 592, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status). Additionally, Mullins thanked the Congressman for his continued support of pharmacy compounding.
- Congressman Dave Loebsack (D-Ia.) who is an original sponsor of H.R. 1316, Prescription Drug Price Transparency Act (MAC), original cosponsor of H.R. 592, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status) and a current cosponsor of H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR).
- House Republican Conference Chair, Congresswoman Cathy McMorris Rodgers (R-Wa.) who is an original cosponsor of H.R. 1038, Improving Transparency and Accuracy in Medicare Part D Spending Act (DIR), original cosponsor of H.R. 1316, Prescription Drug Price Transparency Act (MAC), original cosponsor of H.R. 592, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status) and current cosponsor of H.R. 1939, Ensuring Seniors Access to Local Pharmacies Act (Preferred Networks/AWP).
Three New Pharmacy Quality Measures Endorsed at PQA Annual Meeting: This week the Pharmacy Quality Alliance (PQA) hosted its Annual Meeting. Independent community pharmacy was well represented at the meeting which is a gathering for providers, payers and other interested stakeholders. NCPA member Tripp Logan participated on a panel that included plan sponsors, PBMs, policymakers and pharmaceutical manufacturers discussing the evolving nature of measuring pharmacy performance. Other NCPA members presented research outlining quality measurement in the community pharmacy setting. Of importance, PQA will begin to focus more attention on the creation of pharmacy level measures. Three new measures were voted on by membership for endorsement and all three passed. The measures include: Treatment of Chronic Hepatitis C: Completion of Therapy; Polypharmacy: Use of Multiple CNS-Active Medications in Older Adults; and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults.
NCPA Weighs in on Ways and Means Medicare Hearing: The Ways and Means Health Subcommittee held the hearing to examine the “Current Status of the Medicare Program, Payment Systems, and Extenders”. We encouraged the committee to address the growing problem of Pharmacy “DIR” fees and consider H.R. 1038 that would ban retroactive DIR fees; requested CMS to review and standardize how Part D plans measure pharmacy quality performance measures; to consider H.R. 1316 (MAC Transparency) legislation to increase transparency in how generic drugs are priced by PBMs and paid for in Medicare and other federal programs; to consider H.R. 1939 that would ensure seniors can use the pharmacy of their choice; and to consider H.R. 592 that would expand pharmacy access for beneficiaries in underserved areas.
Health Subcommittee Reports Legislation to Reauthorize FDA’s User Fee Agreements: On a voice vote, as amended, the subcommittee advanced the bill that is intended to assure that the FDA has the necessary resources to deliver safe and effective drugs, devices, and treatments, to patients more swiftly. The full committee is expected to consider the bill in the near future.
Senate Finance Committee Passes CHRONIC Care Act that Includes Med Adherence Language: On May 18, the Senate Committee on Finance unanimously passed bipartisan legislation, S. 870, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, introduced by Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR), as amended. The Committee adopted the Chairman’s Mark of the legislation, as modified by additional changes posted by the Committee, by a unanimous 26-0 roll call vote, after also adopting an amendment by voice vote regarding medication adherence. The Chairman’s Mark includes provisions to expand Medicare beneficiary access to telehealth services, including services for stroke and home dialysis, extend the Center for Medicare & Medicaid Services (CMS) Independence at Home demonstration, and require Government Accountability Office (GAO) studies of comprehensive care planning, medication synchronization, and the impact of obesity drugs on patient health and spending. In addition, the Committee adopted by voice vote an amendment on medication adherence by Senators Carper and Pat Roberts (R-KS) to require HHS to establish a process for Medicare Part D plans to request Medicare Parts A and B claims data to design programs for the appropriate use of medications, building upon a Center for Medicare & Medicaid Innovation (CMMI) demonstration that permits certain plans to request this information. The legislation, as amended, will next be considered by the full Senate.
Don’t Burden Pharmacies With a Nebulous Environmental Rule, NCPA Says: NCPA has urged the Environmental Protection Agency not to proceed with a proposed rule that seeks to establish a new regulatory approach for disposing of pharmaceuticals. The comments were submitted in response to an EPA Request for Information on “regulations that may be appropriate for repeal, replacement or modification.” NCPA said the proposal would increase costs and regulatory burdens on small business pharmacies with no environmental benefits identified under much of the proposed rule.
In the States:
- Oregon: H.B. 2388 was signed into law by Gov. Brown. H.B. 2388 allows the Department of Consumer and Business Services to deny, revoke or suspend registration of a PBM if the PBM engages in specified conduct. The bill also authorizes the department to adopt a fee structure for registration.
NCPA Roundup of 2017 In-District Pharmacy Visits with Legislators: Since January, nearly 20 members of Congress or their staff have either visited an independent pharmacy or met with pharmacists in the district, with several additional visits pending. Some of these meetings were with members of key committees with jurisdiction over independent pharmacy’s legislative priorities. Others were with members, including several with new members of Congress, seeking to learn more about the issues. But in every case, this in district engagement either helped legislators understand the role independent pharmacists play in the health care system, the challenges they face and the need for legislative action or provided pharmacy champions with additional information and examples to fight for legislative remedies.
There are several upcoming opportunities to engage members of Congress while they are in the district. Congress will be on recess for Memorial Day from May 26-June 5, for Fourth of July from July 1-10, and for their annual August recess from July 29-September 4. If you are interested in engaging with a member during one of these periods, some helpful tips are available here. You can also contact Michael Rule at (703) 838-2617 or firstname.lastname@example.org for assistance.
Members of Congress Participating in a Pharmacy Visit or In District Meeting:
Rep. Robert Aderholt
Rep. Jim Banks
Rep. Don Beyer
Rep. Buddy Carter
Rep. John Carter
Rep. Doug Collins
Rep. Barbara Comstock
Rep. John Duncan (staff)
Rep. Drew Ferguson
Rep. Brian Fitzpatrick
Rep. Bob Gibbs (staff)
Rep. Richard Hudson
Rep. Jim Jordan
Rep. Billy Long
Rep. Tom Marino
Rep. Tim Murphy
Rep. Kurt Schrader
Rep. Jose Serrano (staff)
Rep. Bruce Westerman
NCPA in the News: Why This PBM Comparison Is a Bit of a Whopper: Are pharmacies really comparable to fast-food outlets? By B. Douglas Hoey, RPh, MBA, National Community Pharmacists Association CEO, Drug Topics