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.

Impeachment is not the only game in town | NCPA Executive Update | December 6, 2019

by NCPA | Dec 06, 2019

Dear Colleague,

Doug Hoey

Over Thanksgiving, my dad told me he wasn't happy with his and mom's Medicare Part D plan and asked me if I would help him look for a different plan. Dad is a retired pharmacist, so he's got an advantage over most seniors but even then, sifting through Medicare's planfinder.gov is like navigating a maze blindfolded while hopping on a pogo stick.

Fortunately, neither mom nor dad take many prescriptions. The problem, of course, is that they are paying inflated costs for their prescriptions because of pharmacy DIR fees. Pharmacy DIR fees are costing taxpayers $9 billion more at the counter, according to government estimates. That $9 billion in extra costs is put on the backs of the people who use the benefit — the more prescriptions a senior takes, the more likely it is they are paying a bigger share of that $9 billion in extra costs.

NCPA has made this point dozens of times with HHS and White House officials, and continues to pound this point home. Lately it feels like all of the impeachment talk has sucked most of the oxygen out of Washington, but there is still other work being done. This week NCPA reiterated in letters to the Trump administration and key Senate and House committees the harm pharmacy DIRs are inflicting on seniors and pharmacies and the absolute urgency to eliminate pharmacy DIRs as we know them.

Although pharmacy DIRs are the biggest acute issue facing community pharmacies and their patients, NCPA is looking beyond pharmacy DIRs. Exciting new legislation has been introduced in the House, including H.R. 4946 by Reps. Peter Welch (D-Vt.) and Morgan Griffith (R-Va.) that among other things would:

  • Require that pharmacies are reasonably reimbursed and PBMs are not reimbursing their affiliated pharmacies at a higher rate.

  • Open Part D networks to any willing pharmacy in medically underserved areas.

  • Require PBMs to provide claim level reports to pharmacies so pharmacies have a clearer understanding of their reimbursement.

Click here for NCPA's one-page summary of this strong bill. This bill is a game changer for community pharmacies and their patients!

More great news for community pharmacies and the patients we serve came out this week when the U.S. Solicitor General's office recommended that the Supreme Court review the PCMA versus Arkansas court case after an appeals court had ruled against a new patient- and pharmacy-friendly state law. The first paragraph of the solicitor general's discussion section summed it up nicely:

"The court of appeals held that ERISA preempts Arkansas's regulation of the rates at which PBMs reimburse pharmacies. That decision is incorrect. It is contrary to this Court's precedent and the decisions of other courts of appeals on an important question of federal law. And this case is a suitable vehicle for this Court's review ..."

There is still no guarantee that the Supreme Court will choose to hear the appeal, but the strong opinion from the U.S. Solicitor General increases the odds and is helpful language for other ongoing and future efforts. NCPA has been active in this effort from the beginning and commends the Arkansas Pharmacists Association for its work. Much more to come.

NCPA's vision for the future of pharmacy is closely aligned with CPESN® USA, in which pharmacies are paid for the services that are ensuring and improving quality, along with product dispensing. In the meantime, legal and legislative battles will continue and NCPA will continue its advocacy for a bright future for community pharmacies. And, hopefully as part of that future, I can find a Part D plan to recommend to my mom and dad that doesn't inflate how much they pay for prescriptions.

Best,

Doug Hoey

 

Douglas Hoey, Pharmacist, MBA
NCPA CEO