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.

Postcards From the States: 2017 Legislative Successes | NCPA Executive Update | June 23, 2017

by NCPA | Jun 23, 2017

Dear Colleague,

Doug Hoey

Washington, D.C. is one gigantic traffic hairball. The highways tend to move at a snail's pace around here. Eventually you make it home, but it takes awhile. Same goes for legislation. The jams in Congress are often not any more forwardly mobile than the ones out on the Beltway that circles our nation's capital.

But in the states, it's different, at least as far as legislation goes. There, where lawmakers are bound by real deadlines and limited time in-session, the policymaking seems to move faster.

The federal government is still the big fish, of course. More than 50 percent of prescriptions are paid directly or indirectly by federal programs. But the bureaucracy in state Capitals is simply not as extensive as on the federal side.

This year in particular, state legislatures have been a free-flowing route for community pharmacy legislation. The engines behind those pro-pharmacy, pro-patient bills, our state partners, have had success on a number of fronts.

While the subjects of those new laws run the gamut, I note two distinct themes among the dozens of successes this year: Patient protections and pharmacy fairness.

Patient Protections
This year has seen at least three states pass omnibus patient protection bills that will assure patients' choice, improve patients' medication access, enhance patients' understanding of their prescription drug benefits, and save patients money. Unlike some of the more complicated issues we sometimes have to explain to legislators, these protections are easy to understand and easy to justify. For example, it's hard to argue that a patient should pay a co-pay higher than the reimbursed cost of the medication itself (though, granted, PBMs often do).

All in all, a number of states have passed patient protections thus far in the 2017 legislative sessions:

  • At least four states have prohibited co-pay clawbacks.

  • At least four states have prohibited gag clauses, in which pharmacists were inhibited from discussing less expensive medication or payment alternatives with their patients.

  • At least three states will now allow pharmacists to prescribe hormonal contraceptives.

  • At least two states have outlawed PBMs from prohibiting in-network pharmacies from providing home delivery services.

  • One state has passed an anti-retaliation measure.

  • A handful of states have passed med sync legislation.

Pharmacy Fairness
On the other theme—pharmacy fairness—the states have made great strides as well.

Two states have passed laws prohibiting a PBM from requiring additional accreditation or credentialing beyond the requirements of the state board of pharmacy.

Tennessee passed legislation allowing the state employee health plan to compensate pharmacists as Medicaid providers under a new two-year pilot program through which pharmacists provide MTM services to Medicaid beneficiaries. That new law also allows pharmacists in collaborative practice agreements with physicians to be reimbursed for providing MTM to the sickest and most expensive patients enrolled in the state Medicaid program. I mention Tennessee by name because this program is one of the first of its kind.

Additionally this year:

  • At least three states have passed or strengthened laws providing authority for regulatory oversight of or requiring registration of PBMs.

  • At least two states have prohibited PBMs from charging fees related to the adjudication of a claim.

  • One state has placed constraints on self-referral by PBMs to pharmacies or mail order facilities in which the PBM has an ownership interest.

  • One state has authorized its HHS department to audit PBMs that subcontract with MCOs.

  • One state has passed legislation strengthening its MAC transparency statute.

It's been a great, productive year for community pharmacy legislation so far, and some states aren't even done yet. As the year progresses, we'll continue to support our state partners in moving pro-patient community pharmacy legislation on down the highway.

Doug Hoey

P.S. As you're making choices about which pharmacy conventions you'll attend this year, take a moment to think about what makes this year's NCPA Annual Convention in Orlando a not-to-be-missed event. If you're a pharmacy owner, there's simply no better place to make connections and expose yourself to new ideas that you can translate into solutions to your biggest pharmacy business challenges—all at an affordable rate. So don't just sit there. Do something for your pharmacy: Register now for NCPA's Convention 2017.