NCPA created the Advocacy Center to fight for the nation's 23,000 independent pharmacists and their patients because pharmacists play a vital role in health care. NCPA works on many issues affecting community pharmacy including Health Care Reform, Medicare Part D, Medicare Part B DME accreditation, PBM transparency, stopping mandatory mail order and Medicaid issues.
We work on Capitol Hill and in the courts to defend access to this critical sector of the health care system. We hope you'll learn more about the Advocacy Center and what you can do to get involved. You can make a difference. We have delivered thousands of messages to members of Congress this month, join the growing chorus!
Download the Independent Community Pharmacy Congressional Checklist to see what we are asking Members of Congress to support to strengthen your neighborhood community pharmacy and the patients that they serve.
Pharmacy Benefit Managers / Mail Order
Pharmacy Benefit Managers, often known simply as "PBMs," are largely unrecognized by most employees—and even by many employers and human resource managers. But they have a tremendous impact on U.S. health care decision-making because they influence more than 80 percent of drug coverage. The information below is intended to summarize controversial PBM practices, provide a record of NCPA's efforts regarding PBMs as well as any bills that have been introduced or any laws that have been passed on a state level regarding their practices. This section also includes information about the ongoing FTC investigation of CVS Caremark.
Don't let the insurance company middlemen inflate costs and reduce the quality of health care. Support Federal and state efforts to regulate PBMs, as well as halt mandatory mail order in its tracks. Model state legislation, a listing of state laws concerning PBMs, a listing of lawsuits involving them and other resources are available for your use.
Given the critical role that the individual states have in the implementation of federal healthcare reform and Medicaid expansion, NCPA is expanding its bandwidth and involvement in state legislative and regulatory activity. NCPA state government affairs efforts will be focused on PBM audit reform, MAC generic pricing transparency, Medicaid-related issues and federal healthcare reform implementation (exchanges). In addition, NCPA will be actively supporting efforts to implement and expand pharmacist provider status or securing reimbursement for pharmacist-provided services.
Community pharmacies provide cost-saving medication and pharmacy services to millions of Medicare Part B and D patients. Congress and the Centers for Medicare and Medicaid Services (CMS) are making changes to the program all the time. This section lists important changes that community pharmacists should know about and chronicles the NCPA Advocacy Centers efforts to ensure pharmacist can continue serving their patients and getting reimbursed appropriately for their services.
Independent community pharmacies are the backbone of Medicaid’s drug benefit, providing prescription drugs and pharmacy services to Medicaid patients. This section provides important information about NCPA’s efforts on behalf of community pharmacists and patients regarding Medicaid fee-for-service and managed care, Medicaid reimbursement, and other Medicaid issues.
NCPA has formed a Long Term Care Pharmacy Division to better meet the needs of the many community pharmacies that serve long term care facilities and other assisted living facilities. These issues include Part D short cycle dispensing as well as “nurse as agent” in the dispensing of controlled substances.
NCPA has been active in assuring that provisions of the new health care reform law are implemented in a manner that is favorable for community pharmacies and our patients. Millions of new individuals will have insurance coverage through Medicaid and state-based insurance exchanges starting in 2014, including prescription drug coverage. New PBM transparency requirements are also required in these exchanges.
Small business legislation and regulation significantly affect community pharmacies. NCPA monitors and takes action on initiatives that would create a more positive business environment for community pharmacies by promoting lower taxes, fewer regulations, and less unnecessary government oversight.
Professional Practice Issues
NCPA works to create a professional practice environment for community pharmacies that allows them to expand their patient care services. We follow issues such as Board of Pharmacy regulations, DEA regulations, FDA guidances, pharmacy accreditation, drug abuse, drug disposal, medication therapy management initiatives, accountable care organizations, and health records interconnectivity.
NCPA continues to urge the opening of "preferred networks" to any provider willing to accept the contract terms and conditions. To that end, and to support our members' advocacy efforts, we are making available the toolkit of resources below.
A congressionally mandated five-year pilot program for military retirees that requires TRICARE for Life (TFL) beneficiaries to receive certain covered brand-name maintenance medications by mail order or from military pharmacies began Feb. 14. Beneficiaries may apply for a waiver from the program now or opt out after one year of participation. NCPA has repeated and strenuously voiced its concerns with this mail order program and continues to oppose it.
To help clarify confusing information that your patients may have received regarding the program, NCPA has prepared a one-page letter outlining some of the changes that you can personalize with the name of your pharmacy and give or mail to affected patients.
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