The three biggest items on NCPA's agenda are generic drug pricing, fairness in preferred pharmacy networks, and provider status.
The National Community Pharmacists Association (NCPA) continues to advocate for its members in the areas of generic drug pricing transparency and timely updates, fairness in Medicare Part D preferred pharmacy networks, and the recognition of pharmacists as providers under the Medicare Part B program.
B. Douglas HoeyAt the NCPA 2015 annual convention, held in October 2015 in National Harbor, Md., NCPA CEO B. Douglas Hoey and incoming NCPA President Bradley J. Arthur outlined some of the challenges that independent pharmacies face today and what the organization is doing to help address these issues at the federal level.
“Our members have talked with us about slow and low MAC payments and the rash of DIR [direct and indirect remuneration] fees, and clawbacks that are hitting their pharmacies for tens of thousands of dollars,” said Hoey during a media call from the NCPA meeting. “Also, the steering of patients to preferred networks for Medicare Part D is another big challenge facing our industry.”
NCPA members have expressed their frustration with marketplace conditions that make it very difficult for independent pharmacies to compete. NCPA’s “government affairs staff has been working tirelessly to look at legislative fixes,” said Arthur.
The three top legislative priorities of NCPA members are gaining traction in Congress, said Steve Pfister, NCPA’s senior vice president of government affairs, who spoke on the media call.
“We have introduced legislation on all of these top-of-mind issues for our membership in the 114th Congress,” he said.
In the area of pricing transparency for generic drugs and payment updates in Medicare Part D, a win for independents will take effect Jan. 1, 2016, when MAC pricing becomes subject to mandatory 7-day updating by Part D sponsors and their PBMs, Pfister said.
“We are working with Congressional allies and other stakeholders to ensure that CMS strongly enforces this rule, and those efforts will continue,” he added.
NCPA has advocated for legislative proposal H.R. 244, The MAC Transparency Act, introduced in January 2015 by Reps. Doug Collins (R-GA) and Dave Loebsack (D-IA), which would codify provisions in the CMS rule for increased transparency of generic drug payment rates in Medicare Part D. It would apply as well to the Federal Employees Health Benefits Program and Tricare. This bill has 29 co-sponsors, Pfister said.
The “any willing provider” provision, which had been part of the 2014 CMS rule but was not advanced in the final rule, would have permitted independent community pharmacies to participate in Part D preferred pharmacy networks if the pharmacies could meet the terms and conditions of the contracts.
However, there is bipartisan support for H.R. 793 and S. 1190, the Ensuring Seniors Access to Local Pharmacies Act, which would allow pharmacies to participate in Medicare Part D preferred pharmacy networks if the pharmacies are located in areas that are medically underserved or have populations that are medically underserved, or where there is a shortage of healthcare professionals. In February 2015, Representatives Morgan Griffith (R-VA) and Peter Welch (D-VT) introduced H.R. 293, which now has 60 co-sponsors, and in May 2015, Sens. Shelly Moore Capito (R-WV), Tom Cotton (R-AR), Joe Manchin (D-WV), and Sherrod Brown (D-OH) introduced S. 1190, which now has 10 co-sponsors.
Bipartisan legislation has been introduced to support recognition of pharmacists as providers under Medicare Part B. H.R. 592 and S. 314, Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status). It would allow pharmacies in medically underserved areas to provide and receive payment under Medicare Part B for services within their state’s existing scope of practice. The legislation would allow pharmacists to be reimbursed at 85% of the physician fee schedule.
“H.R. 592 now enjoys 218 co-sponsors, which represents a majority in the House of Representatives. The companion legislation, S. 314, was introduced by Sen. Chuck Grassley (R-IA) and a number of other senators in bipartisan fashion and that legislation has 31 co-sponsors,” Pfister said. “The next step on the provider status legislation … will be to gain the requisite congressional budget office score, so that the proposal can move forward. We could see a score on this legislation as early as Thanksgiving, Pfister said. “We are not there yet. But a session of Congress is a two-year process. We are in year one. It has broad bipartisan support, so we are optimistic.”