NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every Friday.

DIRs Exposed; Pharmacist Services Recommended | NCPA Executive Update | January 27, 2017

by NCPA | Jan 27, 2017

Dear Colleague,

Doug Hoey

For several years, NCPA has been sounding the alarm about the inappropriate use of community pharmacy DIR fees. It has taken multiple meetings, conference calls, letters from the Hill, introduction of legislation and finally the Centers for Medicare & Medicaid Services (CMS) has acknowledged our concerns with retroactive pharmacy direct and indirect remuneration (DIR) fees. They have had a detrimental effect on pharmacies, Medicare Part D patients, and taxpayers, we told CMS. In an analysis released recently, the agency agreed.

This is a breath of fresh air and good news. CMS has acknowledged that there is smoke here and that there may be fire. Importantly, NCPA membership deserves some credit. Last summer and fall, NCPA asked its members to reach out to their members of Congress—first to ask that CMS finalize DIR guidance, and then to ask their lawmakers to cosponsor DIR legislation. In just six weeks, NCPA members sent more than 10,000 messages to their legislators asking them to support DIR legislation. You played an important part in this break-through.

The question now becomes, "Where does this go next?" First, this analysis is a key addition to advance our membership's No. 1 legislative and regulatory priority: eliminating the inappropriate use of community pharmacy DIRs after point-of-sale. Secondly, I see these DIRs as an important element in the unfolding larger political debate about drug prices and the role PBMs play in contributing to higher drug costs.

Clearly, addressing drug costs are on President Trump's agenda. He spoke about them on the campaign trail. Post-election he said big pharma was "getting away with murder" and he was going to stop it. This week Trump reached out to Rep. Elijah Cummings (D-Md.), a critic of drug manufacturers, PBMs—and Trump, to talk about what can be done about drug prices.

Importantly, while one of the big keys to controlling drug costs is getting a handle on how much PBMs contribute to the costs of the drug, gaining PBM transparency doesn't necessarily translate to unlocking the patient care potential of the pharmacist and business success for community pharmacies. The second half of the equation is allowing pharmacists to use their expertise to help lower overall health care costs. In addition to the CMS study on DIRs last week, the Director of the Center for Medicaid and Children's Health Insurance Program (CHIP) Services released guidance addressing flexibilities that states may have to facilitate timely access to specific drugs by expanding the scope of practice and services that can be provided by pharmacists.

This includes:

  • Dispensing of drugs based on independently initiated prescriptions,

  • Dispensing of drugs based on collaborative practice agreements with other licensed prescribers,

  • Dispensing of drugs based on standing orders issued by the states or other predetermined protocols.

  • Includes the ability for pharmacists to dispense naloxone for individuals, prior to overdose emergencies.

  • References nicotine replacement therapy and other tobacco cessation treatment

  • References emergency contraception as options for states to consider

  • Expanding the ability of pharmacists to prescribe, modify, or monitor drug therapy in order to address pressing public health issues.

We need to keep this momentum. A great way is to come to Washington, D.C., April 26-27 for the Congressional Pharmacy Fly-In. We've made it shorter and less expensive, as you requested. To be effective, we need you to come here and meet with your lawmakers on DIRs, the PBMs' role in raising drug prices, and what community pharmacists can and are doing to address costs and improve patient outcomes.

Doug Hoey

P.S. There will be more to prepare you for where the community pharmacy market is heading at NCPA's Multiple Locations Conference next month in San Diego. I hope to meet you and talk with you there!