NCPA Advocacy Center Update: Week Ending November 17, 2017

CMS Proposes Part D Changes, Including to Pharmacy DIR: In a 713-page proposed regulation covering an array of topics, the agency proposes to account for all pharmacy DIR at point-of-sale, as NCPA has recommended. CMS argues that the change would increase drug pricing transparency and lower costs for beneficiaries. The proposed regulation also attempts to address controversial PBM practices that hinder community pharmacy participation in Part D, with CMS at times citing NCPA. Please find a detailed summary attached. NCPA will submit comments to CMS before the Jan. 16 deadline and aggressively support key provisions.

President Trump Nominates Alex Azar as Secretary of HHS: The Senate HELP committee announced a Nov. 29 hearing on his nomination. A former senior HHS official and President of Eli Lilly, Azar has articulated views about prescription drug prices considered critical of health plans and PBMs. NCPA expressed an eagerness to work with him, should he be confirmed, and will utilize the nomination process to raise issues important to community pharmacists.

Senate, House Pass Defense Authorization Bill with MAC Provision: President Trump is expected to sign the bill into law, including an NCPA-backed provision to extend to TRICARE the nearly two-year-old Part D requirement that PBMs provide pharmacies more information about their compensation and update their MAC lists every seven days. NCPA thanks the leadership of Sen. Roger Wicker (R-Miss.) and Reps. Doug Collins (R-Ga.) and Austin Scott (R-Ga.), as well as Chairman John McCain (R-Ariz.), Ranking Member Jack Reed (D-R.I.), Chairman Mac Thornberry (R-Texas), and Ranking Member Adam Smith (D-Wash.). Unfortunately, re-authorization for the pharmacy pilot program was not included in the final legislation.

NCPA to Attend Upcoming FDA Compounding Advisory Committee Meeting: NCPA submitted comments in advance of the session, which will consider six bulk drug substances nominated for inclusion on the section 503A Bulks List, including NCPA’s nomination of Resveratrol, 7-Keto Dehydroepiandrosterone, L-Citrulline and Pregnenolone.

House GOP Passes Comprehensive Tax Reform 227-205, with 13 Republicans joining all Democrats in opposition. After the adoption of a manager’s amendment that provided tax relief to small business pass-through entities, the National Federation of Independent Business (NFIB) reversed their opposition to support the bill. The new 9 percent tax rate for the first $75,000 of income for a married active business owner with less than $150,000 in pass-through business income, as well as the repeal of the estate tax, is a win for independent community pharmacies, which is why NCPA advocated for and endorsed these provisions of the House tax reform package. However, questions remain about whether the Senate can advance tax reform. While their bill did clear the Senate Finance Committee on Thursday in a party-line vote, lingering concerns about increased deficit spending, temporary tax breaks for individuals, and the last-minute decision to include the repeal of Obamacare’s individual mandate make passage far from certain in the upper chamber as Republicans can only lose two votes with Democrats’ opposition appearing unanimous. The Senate will continue negotiations over the holiday and hope to bring the package up for a vote on the floor after Thanksgiving. Currently, there are key differences between the House & Senate tax bills. If the Senate has the votes for passage, these differences would have to be worked out with the House in a conference committee.

NCPA Talks Need for PBM Transparency, Pharmacist Utilization: Pharmacists are poised to play a greater role helping address adherence and to better utilize the drug benefit to drive better overall health outcomes and costs, NCPA CEO Doug Hoey argued in a Washington symposium featuring PhRMA, PCMA and others. The complexity of the system requires plan sponsors to use PBMs whether they like it or not, he added, as there’s no PBM handbook for dummies.

House Bill Targets 340B Cuts to Hospitals: Rep. McKinley (R-W. Va.) introduced H.R. 4392, which would block a recent CMS final rule on Medicare Hospital Outpatient Prospective Payment System (“OPPS”) in the 340B program. That rule would cut hospital reimbursement by almost 30 percent ($1.6 billion) for drugs purchased through the 340B program, but these cuts would be limited to just physician administered drugs reimbursed under Medicare OPPS. In contrast, drugs dispensed at contract pharmacies under the 340B program are generally self-administered retail drugs and would not be impacted by the cuts in CMS’ finalized rule. NCPA will closely monitor any changes to the 340B program that will have an adverse impact on contract pharmacies participating in the program.

44 AGs Urge Congress to Repeal Bipartisan Opioid Epidemic Law: Their letter focuses on The Ensuring Patient Access to Effective Drug Enforcement Act, which passed the House and Senate without dissent last year.

GAO Report Finds Cost Burdens Limit Pharmacy Participation in Drug Collection, Disposal: Specifically, GAO interviewed NCPA and other stakeholders who said the expenses of bin installation, ongoing personnel training and contracting with a reverse distributor – and doing so in compliance with DEA requirements – are cost-prohibitive. Three percent of pharmacies and other eligible entities participated and pharmacies account for 81 percent of these authorized collectors. At the high end, 32 percent of pharmacies and eligible entities participate in takeback in North Dakota, where the Board of Pharmacy finances the effort.

NCPA Participated in a Joint LTC Definition Work Group Meeting This Week: Participants included representatives from SCPC, ASCP and several long-term care pharmacy operators. The goal of the group is to create a definition of long-term care pharmacy that recognizes the enhanced services that these pharmacies provide in a variety of care settings.

What Does 2018 Hold for Community Pharmacy? Find out during an NCPA Members Forum on the Community Pharmacy 2018 Checklist Dec. 7 at 2 p.m. ET. NCPA Advocacy Center staff will make sure you are up-to-date on the new Administration’s impact on small business community pharmacy, NCPA’s federal and state legislative priorities, and topics such as Medicare, Medicaid, Tricare, regulatory compliance deadlines, compounding, and track & trace, among others. This webinar is open to NCPA members only. Register here.

Fighting Medicaid Managed Care (MMC) Reimbursement Cuts: NCPA continued to engage and advise pharmacies and state partners regarding reimbursement cuts in state Medicaid plans administered by CVS Caremark. It’s important for pharmacists and state partners to: 1) contact your state Medicaid agency to protest below-cost reimbursement rates and highlight that these reductions may result in decreased beneficiary access to medication. Also point out CMS’s final rule on network adequacy requirements in MMC; 2) re-examine any state MAC laws for their applicability to MMC; and 3) consider 2018 legislation to require MCOs to reimburse at FFS rates and subject MCOs to state MAC laws. Use NCPA comments about MMC in your arguments. Finally, NCPA developed a sample letter, available upon request, to assist pharmacies that want to engage their local elected officials.