Update: Community pharmacy

September 10, 2014

NCPA's midyear summary tallies what's been done and what's in the works.

B. Douglas HoeyLate last year, NCPA asked the membership to tell us what its top legislative priorities were, going into 2014. Two issues stood head and shoulders above the rest: exclusionary “preferred pharmacy” networks and lagging MAC updates to generic drug reimbursement. Significant progress has been made on both fronts, but still there is much more to do.

Congress recently returned to Washington from its annual summer recess. During their time back home, lawmakers heard from pharmacists, patients, and other stakeholders about preferred networks limiting patient access to community pharmacies. In light of this recent flurry of grassroots activity, now is a fitting time to reflect on the year so far and the work that remains. 

MAC

In January, Medicare officials reacted to longstanding concerns raised by NCPA and its members by proposing a regulation addressing several important issues. A few months later, Medicare finalized a revised version of the regulation. It included a requirement that, starting in 2016, drug plans/pharmacy benefit managers (PBMs) must update maximum allowable cost (MAC) lists once every seven days to ensure that pharmacies are reimbursed appropriately for generic drugs. Although more work is needed to resolve the issue caused by delayed MAC payment updates, this is a major advance.

A bipartisan bill is pending that would strengthen the aforementioned MAC reforms that Medicare is implementing. H.R. 4437, the Generic Drug Pricing Fairness Act would codify the Medicare regulation and would add additional patient protections.

Unfortunately Medicare delayed, at least for now, its proposals to increase access for beneficiaries to medication therapy management (MTM) and require that “any willing pharmacy” be allowed to participate as a “preferred” pharmacy.

 

 

Pharmacy access

Subsequently, with NCPA’s active involvement and support, legislation was introduced in Congress for the first time that would address some of the pharmacy access issues created by preferred networks in Medicare.

The bipartisan Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577), put forth by Representatives Morgan Griffith (R-Va.) and Peter Welch (D-Vt.), would allow any pharmacy located in a medically underserved area the opportunity to participate as a preferred pharmacy, so long as it is willing to accept the drug plan’s contractual terms and conditions.

NCPA is leading the Any Willing Pharmacy Coalition to unify community pharmacy’s message. At the time of this writing, nearly 50 organizations have pledged to work to rally support for the legislation.

Provider status and more

In addition, separate bipartisan legislation in the House seeks to increase the healthcare services available to patients by recognizing pharmacists as healthcare providers under Medicare. H.R. 4190 would allow pharmacists in medically underserved areas to offer all services permissible under their state laws to Medicare patients and receive reimbursement for such. This would also help alleviate some of the problems caused by physician shortages.

Pharmacists in 11 states helped pass MAC transparency legislation, bringing the total to 16 states that have enacted such legislation. In addition, the number of states that have enacted fair and uniform pharmacy audit laws grew to 31.

We have seen a number of successes so far this year. The coordinated and unified voice of community pharmacists is being heard in a difficult political environment. Our priorities are gaining the attention of policymakers. However, there is still much to be done.

 

How to help

To pass these bills, we need action, and that means you! One way is to attend NCPA’s Annual Convention (for information, please visit www.ncpanet.org), taking place in Austin October 18-22, 2014. Not only does the convention serve as a rallying point, where you will learn what you can do; you can also connect with others and learn the latest practices making pharmacy owners successful.

We hope to see you in Austin, but if you are unable to attend, please visit NCPA’s Pharmacy Choice website (www.ncpanet.org/pharmacychoice) for resources and tips on making your voice heard by your elected officials.

B. Douglas Hoeyis CEO, National Community Pharmacists Association.