Nearly 250 pharmacists and others will descend on Washington, D.C. on April 26 and 27 for the NCPA 2017 Congressional Pharmacy Fly-In, to advocate for issues relating to community pharmacies. Doing away with DIR fees will be one of their top priorities.
The biggest issue that pharmacists will address with legislators is DIR fees, but other major issues include: equitable maximum allowable cost (MAC) prices, pharmacist provider status, Affordable Care Act (ACA) reform, and ensuring seniors’ access to local pharmacies.
“Our members’ number one issue is the DIR fees, and the ‘Improving Transparency and Accuracy in Medicare Part D Spending’ bill would end Medicare DIR fees that push seniors into the doughnut hole,” said NCPA’s CEO B. Douglas Hoey, RPh, during a media phone briefing.
“Pharmacists don’t understand the whole clawback fees thing, and why they have to eat those costs. The problem is, we are losing a lot of our community pharmacies, particularly in underserved areas,” said Rep. Morgan Griffith (R-VA), a sponsor of the proposed DIR fees bill.
Griffith’s own pharmacist, employed by a more than 100-year-old independent pharmacy, told him that DIR fees are “tough when they try to fill a prescription. On the computer, it is one price, and then, months later, it is a different price.”
At the Pharmacy Fly-In, pharmacists and pharmacy advocates will also address ACA reforms and stress how pharmacists can play a big role in helping to lower overall health-care costs, according to Hoey.
“If the ACA was completely repealed, it would be detrimental to patients. We are on the watch and we have been on the record for saying, ‘If there is going to be a repeal, please be careful in how you do it so that patient access to valuable prescription drug services is not undermined,’” Hoey said.
ACA reforms should preserve prescription drug coverage as an essential health benefit, NCPA said in a statement. Any reform should also maintain meaningful access to retail pharmacies for patients to fill their prescriptions, preserve Part D improvements to medication therapy management (MTM) services, and keep the current average manufacturer price definition used for Medicaid fee-for-service reimbursements.
Other legislation that pharmacists will be supporting during the Fly-In include:
- Creating Prescription Drug Price Transparency (H.R. 1316): “Generic prescription drugs account for over 80% of medications dispensed by community pharmacies, yet how they are priced by PBMs is a black box,” NCPA said in its statement. The bill would codify Medicare transparency provisions concerning MACs for generics and apply them to TRICARE and Federal Employees Health Benefits (FEHB) Program. “It would also establish a MAC appeals process and prohibit requirements to use a PBM-owned pharmacy—a clear conflict of interest.”
- Ensuring Seniors Access to Local Pharmacies (H.R. 1939): The bill aims to give seniors more access to discounted co-pays for prescription drugs at their pharmacy of choice. “It would allow pharmacies in medically underserved areas to participate in Medicare preferred pharmacy networks if they accept the drug plan’s terms and conditions,” NCPA said.
- Obtaining Pharmacist Provider Status (S. 109 / H.R. 592): The companion bills would recognize pharmacists as providers under the Medicare Part B program. “If enacted, pharmacists would be able to perform services for patients consistent with their state’s scope of practice if their pharmacy is located in a medically underserved area, health professional shortage area, or medically underserved population,” NCPA said.