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 other Friday.

An administration that goes to bat for community pharmacy | NCPA Executive Update | April 12, 2019

by NCPA | Apr 12, 2019

Dear Colleague,

Doug Hoey

Major League Baseball marked Opening Day two weeks ago. What a great day that was. On Wednesday, there was another Opening Day to celebrate, this one in Alexandria, Va. Our 51st Congressional Pharmacy Fly-In kicked off with a rousing speech by longtime community pharmacy friend and champion Rep. Doug Collins (R-Ga.). Collins' pitch was a hard one on the inside of the plate to PBMs – he encouraged members to keep on telling their stories about how patients are impacted by their practices. He revved up the crowd. NCPA President Bill Osborn and I followed him to the podium, and I can tell you that we could both see the excitement and enthusiasm. His message definitely resonated.

We got timely and informative legislative and PAC updates – you'll hear more about those over the next week – and then we heard from our Fly-In MVP, HHS Secretary Alex Azar. The ballroom was packed and as Azar took the stage, he got a lengthy standing ovation.

The secretary started by acknowledging how important independent pharmacists are to the life of their communities. He's paying attention to what we do, having personally visited two NCPA member pharmacies in just over six months.

He got right down to the heart of the matter with this comment:

A changing prescription drug market has meant that high prescription drug costs are still a top concern for seniors and Americans of all ages. The experience at the pharmacy counter shapes what many Americans think about the health care system.

All of you know this well, but it is striking just how the unaffordable and unpredictable costs of drugs can be one of the most stressful aspects of health care.

I've talked to members of Congress who are driven to take prescription drug costs seriously as an issue simply because of massive bills they've been hit with at the pharmacy counter. You likely see this kind of sticker shock every day, and you can play a key role in making it as rare as possible for your customers.

Those words washed over us like that distinctive crack on the sweet spot of the bat. It felt like a collective, "He gets it!"

It got better from there. Azar reiterated the administration's commitment to making health care accessible, affordable, and understandable – and then he brought up pharmacy DIRs and the crowd went wild.

Unfortunately, both issues are real concerns with the current system of direct and indirect remuneration.

We know the burdensome nature of the DIR system can be a real challenge for community pharmacies, while a lot less of a burden for pharmacies owned by the PBM itself.

This, by itself, is bad news for patients who want a competitive pharmacy marketplace and the lowest cost drugs possible.

But we've also heard from many of you that the DIR system isn't being used to improve quality of services at the pharmacy—it's just lowering the reimbursement pharmacies get, without that lower effective price being reflected in what patients pay.

That's why, in this year's Part D draft rule, we proposed requiring that DIR fees be accounted for at the point of sale, so that pharmacies aren't required to pay back retroactive fees long after dispensing the medication a patient needs.

This creates a more level playing field that ultimately serves patients best.

He talked about the Trump administration's plans to lower drug prices but added that if the backdoor deals and rebates stay in place, no change will matter. It comes down to this, he said:

Anyone who stands for rebates, stands for ever-higher list prices, and against transparency and lower patient out-of-pocket costs at the pharmacy. It's that simple.

Azar asked our members to work with the administration to deliver more affordable access to medicines and easier access to better care at a lower cost.

The goal, he said, is to build a health care system that puts the patient at the center, provides them with peace of mind, and treats them like a person, not a number.

At this point, Azar had hit a grand-slam. Then he added this:

Nobody knows how to do that better than America's community pharmacists, so we look forward to working with you to build the system American patients deserve.

Members jumped to their feet, clapping, whistling, and cheering. It wouldn't have surprised me if someone had lifted him onto their shoulders or doused him with champagne.

Maybe it's early, but I'm making a bold prediction. This is going to be a record season for community pharmacy and the patients we serve.

Read Azar's complete remarks here.


Doug Hoey