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.

New CMS Reg Could Be a Big Win for Community Pharmacy | NCPA Executive Update | December 1, 2017

by NCPA | Dec 01, 2017

Dear Colleague,

Doug Hoey

Shortly before Thanksgiving, the Centers for Medicare & Medicaid Services released a proposed regulation that could have been a big, fat turkey. Instead, it could be a plum for community pharmacists and the seniors we serve.

On average, about one out of every three prescriptions filled in an independent pharmacy is for a Part D patient. That’s one reason why NCPA dedicates so many resources to consistently and continually interact with CMS and Congress about the Part D program. Two weeks ago, CMS released a 713-page proposed regulation that could bring necessary change to make the program even better for seniors.

Proposed is important to note. Stating the obvious, proposed is not the same as final.

For example, four years ago, CMS released a much different proposed regulation for Part D. While it too would have benefited community pharmacies and the patients we serve, it also featured much more controversial policies. They triggered fervent opposition from Congress, pharmaceutical manufacturers, and others. That forced CMS to scrap most of the policies it proposed. This time may be different, though.

As mentioned, this newest proposed regulation is longer than three Grisham novels combined, but here are some of the most important areas that could help pharmacies provide better patient care:

  • Considering accounting for all pharmacy DIR at point of sale.
  • Defining "mail order pharmacy" to exclude most independent pharmacies that mail prescriptions.
  • Restating opposition to Part D plans restricting access to certain specialty drugs.
  • Prohibiting Part D sponsors from excluding certain pharmacies from their standard retail networks simply because they compound or offer mail delivery.

We had heard the rumors that this regulation would be coming "any day" for quite some time and were pleased to see what it had to say when it finally arrived. CMS is clearly getting better at understanding gaps in prescription delivery and payments in the Part D program, and this proposed regulation would help close some of the more gaping holes.

Not surprisingly, the PBMs quickly stated their opposition to the provisions community pharmacy supports. The last thing they want is to have transparency into their business dealings with taxpayers. That serves as one more reminder that this proposed regulation won’t make it to final status easily. The process goes like this:

Currently, the regulation is in a 60-day comment period. NCPA will submit comments and actively work with other pharmacy stakeholders to do the same before the Jan. 16, 2018 deadline.

Next, CMS will review and digest those comments. No doubt a few Zantacs might be required in order to digest all of the comments generated by a 700+-page rule.

Then, CMS may make adjustments to the regulation after determining which policies it will advance to final, which ones will need further review or adjustment, and which ones will disappear into the ether.

NCPA will aggressively support the key provisions. Stay tuned for updates from us on how NCPA members and community pharmacy supporters — that means you — can do the same.

Doug Hoey