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.

Here's our New Year's resolution - and it's a keeper | NCPA Executive Update | January 4, 2019

by NCPA | Jan 04, 2019

Dear Colleague,

Doug Hoey

About half of the U.S. population makes New Year's resolutions – and by the end of the month, most of those resolutions have fallen by the wayside. But some resolutions are worth sticking with.

At NCPA, our big idea – one we're pursuing with laser-like attention – is changing the pharmacy payment model. I'll have lots more to say about it in a future column. For now, though, as state legislatures prepare to convene for their 2019 sessions, we have a real opportunity to influence that payment-model-changing at the state level.

In the year ahead, we'll be working with our state partners to pass state legislation that brings transparency to payments, PBM accountability to taxpayers, and fairness to community pharmacies.

I don't have to remind you that for too long, PBM business practices have sucked money from the drug supply chain – money that they've kept as profits while your patients pay more, taxpayers in your state are milked, and your pharmacies are under-reimbursed.

To address some of those problems, NCPA is focused on three priority issues in 2019 state legislative sessions, and we'll be providing substantive support to our state partners to enact these priorities:

  1. Medicaid managed care payment reforms.
  2. Thanks to Ohio pharmacists' efforts this past year Ohioans discovered that PBMs in the state's Medicaid managed care program were reimbursing pharmacies low, billing the Medicaid program high, and taking more than $223 million in spread as profit – that's taxpayer dollars, mind you. We believe PBMs are doing the same in other states' managed care programs. We'll be providing state partners with solutions and resources to address that problem. We outlined a number of those solutions in our November 2018 issue of America's Pharmacist® magazine – everything from carving the drug benefit out of managed care to setting the fee-for-service reimbursement rate as a floor for managed care reimbursements.

  3. Comprehensive PBM regulation.
  4. We'll be working with select states to pass comprehensive PBM regulation patterned after a new PBM model act approved in December by the National Council of Insurance Legislators. NCPA quarterbacked this successful effort by helping draft and lobbying for that model act, and I'm proud of our success. Many states have passed legislation providing regulation of PBMs in one form or another, but PBMs are nothing if not clever and resilient, and they often have managed to avoid full enforcement of those statutes. This model act seeks to rectify that by applying a comprehensive framework of regulation and giving real enforcement authority to state insurance commissioners.

  5. Scope of practice expansion and compensation for patient services.
  6. Properly expanding pharmacist scope of practice and authorizing pharmacists to be paid for certain services has been a longtime goal. The timing has never been better for this kind of pro-patient legislation in states. In fact, a joint report issued last month from HHS and the Treasury and Labor departments urged states to consider exactly this sort of expansion as a means of increasing patient accessibility to quality health care. Patients get a raw deal when their local hospitals close and physician practices consolidate and move away. Empowering pharmacists – America's most accessible health care providers – is the right way to assure that patients can be cared for locally.

Here's where you'll find our 2019 menu of priority issues and resources, as well as contact info for our state governmental affairs team.

Changing the pharmacy payment model in states to one that not only cares properly for patients but also values the role of community pharmacists as America's most accessible – and increasingly essential – health care providers is a resolution worth keeping in 2019. We're on it.

Doug Hoey