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.

NCPA Adds Community Pharmacy 'Flavors' to Health Care Debate | NCPA Executive Update | November 10, 2017

by NCPA | Nov 09, 2017

Dear Colleague,

Doug Hoey

Policymakers sometimes compare the creation of legislation and public policy to "making sausage" (a comparison that actually offends some sausage makers!). Wednesday was a big day at the Washington sausage grinder, and NCPA was invited to help crank the handle.

The Federal Trade Commission has always been of great importance to small business owners, including community pharmacists. This week, NCPA represented community pharmacy at an FTC workshop titled, "Understanding Competition in Prescription Drug Markets."

Susan Pilch, NCPA's Vice President of Policy and Regulatory Affairs, did a great job giving community pharmacy's perspective. She was flanked by representatives from the University of Southern California, the Pharmaceutical Care Management Association, the Pharmaceutical Research and Manufacturers Association, the Health Transformation Alliance, and Drug Channels blogger Adam Fein.

The controversy over rising prescription drug prices has intensified interest in having workshops like this one at the FTC and others in Congress over the last year. Many pharmacists hold the opinion that the FTC has historically had a favorable view of traditional PBM practices, so it was an excellent opportunity for NCPA to explain to the commission and others in the audience and watching online the incredibly complex prescription drug pricing system in the U.S. and the role PBMs may play in contributing to higher costs.

Of course, the FTC was not created to favor PBMs, community pharmacies, or any other business, whether huge or small. Its role is to protect consumers and maintain marketplace competition. We believe that community pharmacies help ensure that there is increased competition in the marketplace, which helps keep health care costs down and quality high. However, there are anticompetitive forces steering patients into specific pharmacies, coercing prescribers and consumers to use certain prescription drugs, and not allowing the market to function as efficiently as it could to help consumers. We gave these recommendations to the FTC for solutions:

  • Pass legislation that creates greater PBM transparency.
  • Realign the incentives so the playing field is level for all stakeholders and costs are not unnecessarily being added to the system.
  • Use outcome-based payments that employ metrics to determine the quality of services being rendered.
  • Minimize the role of PBMs by allowing health insurers and plan sponsors to contract directly with pharmacies.
  • Improve alignment between prescription drug and overall medical spending, increasing medication adherence to stave off costly downstream medical interventions.

The hottest health care topic nationally is the opioid crisis. As the FTC workshop was taking place near the Capitol, NCPA Vice President, Pharmacy Affairs Ronna Hauser and NCPA member George Garmer were an hour up the road in Baltimore with CMS Administrator Seema Verma sharing what community pharmacists are doing to help combat the crisis. NCPA focused on two groups of patients — those who have yet to become addicted and those who need help for their addiction.

Some of the points they highlighted:

  • Expand consumer access to naloxone.
  • Encourage pain relief alternatives for pain management.
  • Establish limits on maximum day supply for certain controlled substances.
  • Prohibit certain controlled substances from being delivered to patients via physician offices or mail.
  • Expand electronic prescribing of controlled substances.
  • Enhance prescription drug monitoring programs.
  • Increase use and access to medication-assisted treatment options.

George was able to share experiences from the pharmacy front line of helping patients not only with the initial treatment for their addiction, but also assisting patients to find the support services they need to stay off opioids. He also talked about the need to help "abandoned" patients — opioid abusers that the health care system is cutting off — find a path forward.

On Wednesday, the sausage grinder was running at full speed. NCPA contributed community pharmacy's ingredients to the process to make sure the end results contained some flavors palatable to pharmacy small business owners and the patients they serve.

Doug Hoey