THE ISSUES
STATE
Individual states play a critical role in the implementation of health care reform. To assist our state partners, NCPA has expanded its bandwidth and involvement in state legislative and regulatory activity. The NCPA state government affairs team focuses on pharmacy-specific issues related to PBM reform, Medicaid, the opioid crisis, and federal health care reform implementation (exchanges). In addition, NCPA actively supports efforts to implement and expand pharmacist scope of practice and to secure reimbursement for pharmacist-provided services.
PBM Reform
Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. Over time, PBMs have been allowed to operate virtually unchecked. A lack of transparency in PBM practices has led some states to implement licensure/registration, fair pharmacy audit, and generic drug pricing legislation to try to level the playing field for pharmacies and patients.
Pharmacy Patient Protections
In the past, pharmacy legislation has often focused on narrow, nuanced issues regarding PBM practices that hurt pharmacies and patients alike. Rather than seek to address one specific practice, NCPA has developed a set of resources that covers a course of actions employed by PBMs that are harmful to both patients and our members.
Medicaid
Medicaid is a joint federal-state program that provides health coverage to certain categories of persons, including children, pregnant women, parents of eligible children, and persons with disabilities. One of its most important benefits is prescription drug coverage. All state Medicaid programs currently provide coverage for prescription drugs, although there are differences in state policies regarding copays, types of drugs that are covered, and the number of prescriptions that can be filled. While Congress and the Centers for Medicare and Medicaid Services set the general rules under which Medicaid operates, each state runs its own program.
Medical Marijuana
NCPA supports the dispensing of all controlled and legend medications, including any legal prescriptions for marijuana, through state board-licensed pharmacies in accordance with applicable laws, rules and regulations. On the state level, medical marijuana legislation may raise the issues that can potentially impact patient access to community pharmacy services. Those issues center on the role of the community pharmacist, compliance with federal law, and impact on business practices.