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NCPA President Brad Arthur rallies the troops.
“The days of pharmacists standing on the sidelines are over, gone, history. You make your own luck. Getting involved and staying involved with deliberative bodies like this one is one way to work to make your profession strong.”
Bradley J. Arthur, RPhAs president of the National Association of Retail Druggists (now the National Community Pharmacists Association or NCPA), my father, Donald Arthur, delivered that message to independent community pharmacists at their annual convention in 1988. I have followed in his footsteps and become an independent community pharmacist and co-owner of two stores, Black Rock Pharmacy and Brighton-Eggert Pharmacy, and now I have been entrusted with the same leadership position my father once held.
While the challenges that prevailed during my father’s presidency have shifted, some things have not changed. Independent community pharmacies have always operated in a tough regulatory environment where some form of governmental intervention is needed, especially when it comes to the business practices of pharmacy benefit manager (PBM) corporations.
Therefore, it makes sense for me to take a leaf from my father’s book and urge independent community pharmacies to advocate for their own interests. In turn, I pledge to work tirelessly to ensure that our allies appreciate us and our adversaries respect us.
One of my first official acts was to testify November 17 on behalf of NCPA at the hearing of the U.S. House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law known as “The State of Competition in the Pharmacy Benefit Manager and Pharmacy Marketplace.”
I covered the gamut of PBM-related problems, from excessive PBM market concentration to take-it-or-leave-it pharmacy contracts; from low and slow generic payment updates to mail-order and specialty pharmacy conflicts of interest. I also raised concerns about the total lack of regulation.
Before any battle, you need a battle plan. For NCPA in 2016, our plan includes acting upon the results from our third annual membership survey of top federal legislative and regulatory priorities. As we go to press, some responses are still trickling in. But the near-final results identified three top priorities for 2016 that affirm that frustration with PBM corporations continues.
First, members want NCPA to address below-cost PBM reimbursements by requiring PBM corporations to disclose generic drug payment (or MAC) methodology and ensure that those benchmarks are updated to reflect market costs. NCPA will continue to generate support for federal legislation (H.R. 244, the “MAC Transparency Act”) to address this issue, and will also advocate for meaningful state action as well as for proper enforcement of a new Medicare requirement for more transparency and updates by Part D plans.
Second, members want “any willing pharmacy” to participate in Medicare Part D “preferred pharmacy” plans if it is willing to accept the terms and conditions offered by the plan. To that end, NCPA will continue to press for federal legislation (H.R. 793/S. 1190, the “Ensuring Seniors Access to Local Pharmacies Act”) to ensure that “any willing pharmacy” in medically underserved areas will be able to participate as a preferred provider in Part D plans.
Third, members want NCPA to address the arbitrary application of PBM corporations’ direct and indirect remuneration (DIR) fees that negatively impact Part D prescription reimbursements to pharmacies. NCPA will develop new strategies to address onerous DIR fees and will continue to urge Medicare officials to implement guidance to regulate PBM corporations in this area.
We need to invest time and resources to ensure that these priorities become victories that enable independent community pharmacies to do what they do best - improve patient outcomes and reduce costs. For too long PBM corporations have been able to rig the system to their benefit at the expense of patients, health plan sponsors, and pharmacies.
Our top three legislative and regulatory priorities are about creating a fairer marketplace. I am optimistic that our hard work will be rewarded. I close with my father’s concluding words from his inaugural speech: “Together, let’s make this the best year yet for the nation’s independents.”
Bradley Arthuris NCPA president and co-owner of two community pharmacies in Buffalo, N.Y.