Federal Legislative News

NCPA OPPOSES ESI-MEDCO MERGER

CONTACT YOUR MEMBERS OF CONGRESS TODAY!

NCPA has launched a Congressional campaign to convince the Federal Trade Commission (FTC) to NOT approve the merger of ESI and Medco. We ask all NCPA members to contact their House and Senate offices and ask them to contact the FTC, urging that the merger be denied. Approval of the merger means higher drug prices, less competition, more egregious PBM practices, fewer consumer choices, and more mail order !Please go to the NCPA website www.ncpanet.org to contact your Member of Congress today! Time is of the essence! Please.

Debt Limit Bill Becomes Law:

The House finally voted on final passage of the debt limit deal. The measure passed by a vote of 269 to 161. 174 Republicans and 95 Democrats supported the package. It then passed the Senate and the bill was signed into law by the President shortly after.

NCPA will now focus its lobbying efforts on the Joint Select Committee on Deficit Reduction, which will be comprised of 12 Members of Congress (appointed no later than 14 days after passage of the bill - Tuesday August 16, 2011). Its charge is to put forth a proposal to cut spending by $1.2 trillion by November 23, 2011, and Congress is required to vote on the recommendations by December 23, 2011. Each Chamber would consider the proposal on an up or down vote without amendments. If the Committee can't agree to recommendations, the President may still request up to $1.2 trillion for a debt limit increase. Such action would activate the "trigger" of $1.2 trillion in across-the-board cuts--half would be Defense cuts and the other half would be non-Defense cuts. Non-defense cuts would exempt Social Security and Medicaid, and only impact providers in Medicare. Medicare cuts could not exceed 2 percent, which is about $11 billion in 2013.

The Members of Congress chosen to sit on the Select Committee will have the daunting task of making spending cut recommendations in a few months time. While Congressional Committees can submit recommendations to the Select Committee no later than October 14th, unquestionably the 12 appointed Members will be crucial in developing the recommended cuts. A number of names are already being floated in both Chambers for the Select Committee. NCPA will follow this process closely and build our lobbying strategy around the structure and timing of the Select Committee.

NCPA is developing an analysis that will document that, combining the cuts to reimbursement in Medicare Part D and Medicaid, community pharmacies have already “given at the office” in terms of cost savings in these Federal programs.

NCPA Survey Shows Negative Impact of PBM Practices on Patient Care, Pharmacies: 

This week, NCPA released a survey of about 1900 of its members, showing how burdensome and onerous PBM reimbursement and auditing practices are standing in the way of good patient care. The survey focused primarily on the fact that PBM contracts do not disclose even basic information on how MACs are set or changed for generics. It also shows how PBMs use audits to harass pharmacists and recover thousands of dollars in legitimate prescriptions dispensed even for the slightest clerical errors. NCPA will be using these surveys to lobby Members of Congress to support H.R. 1971/S. 1058, the Pharmacy Competition and Consumer Choice Act, as well as H.R. 1946, the Save our Independent Hometown Pharmacies Act. A copy of the national survey is attached, but individual results for most states will be on the NCPA website this week.

PCMA: Drugstores Want a “Free Pass” to Avoid FWA Detection: 

In response to the NCPA survey showing how PBMs harass pharmacies with egregious audits, PCMA (the Pharmaceutical Care Management Association, representing the PBM lobby) released a statement saying that “the independent drug store lobby” wants to avoid fraud waste and abuse detection. PCMA came out in opposition to H.R. 1971/S. 1058. Not surprising for the PBM industry, the statement is full of inaccuracies of what the bill contains. PBMs are also interested in taking away the hard-fought Medicare Part D prompt pay provisions enacted in 2008 because they miss the millions of dollars in revenue that they earned from the “float” by keeping community pharmacies reimbursements for excessive periods of time. Make no mistake. The PBMs and their allies are using the FWA issue to hide behind their egregious PBM auditing practices – and are laying the ground work for making a run at the Part D prompt pay provisions. A copy of the NCPA response is attached.

NCPA Weighs in on Legislation Expanding 340B program:

Reps. McMorris Rodgers (R-WA), Rush (D-IL) and Emerson (R-MO) recently introduced legislation to expand 340B drug coverage to inpatient drugs and to repeal the orphan drug exclusion. While these two provisions do not directly impact NCPA, we remain concerned regarding another provision in the proposed legislation which would, to some extent, expand the outpatient program by allowing children’s and rural hospitals to utilize 340B discounts in clinics more than 35 miles from the main hospital. NCPA met with staff members from both congressional offices to raise our concerns.

NCPA Suggests NPI Revisions on FAST Act:

This week NCPA sent to Senators Carper (D-DE) and Coburn (R-OK) suggested changes to the proposed FAST Act legislation. We are requesting that the legislative language state that any and all prescribers shall obtain an individual NPI number and shall affix that individual NPI number to all Part D prescriptions.This would mean thatindividual prescribers could no longer use group NPI numbers andthat medical residents and interns could no longer use teaching physician NPI numbers. We also requested that the legislative language clearly state that the PDPs must bear ultimate responsibility for validating and verifying the NPIs on Part D prescription drug claims. We are further requesting that additional language state that PDPs shall hold harmless suppliers and providers who fail to submit claims with valid NPI numbers despite their good faith best efforts to obtain those numbers. As an alternative option, we are requesting all PDPs institute hard edits to reject claims with invalid NPI numbers at the point of sale.

Congressional Recess:

Earlier this week the House and Senate members left Washington, D.C. for their summer recess. They will be home campaigning in their districts and states until September 6th. Please us this recess to contact them or drop by their local office to educate them about the negative potential impact of the Express Scripts merger and ask support for community pharmacy’s legislative priorities.

NCPA Congressional Visits:

NCPA participated in Hill visits for the following Members of Congress this past week:

• Rep. Janice Schakowsky (D-IL) Member of the Energy and Commerce Committee
• Rep. Linda Sanchez (D-CA) Member of the Ways and Means Committee
• Rep. Jim Jordan (R-OH) Chairman of the Republican Study Committee
• Rep. Tom Graves (R-GA) Member of the Appropriations Committee
• Rep. Don Young (R-AK)
• Rep. Bill Pascrell (D-NJ) Member of the Ways and Means Committee
• Rep. Joe Courtney (D-CT)
• Rep. Mike Fitzpatrick (R-PA)
• Rep. Jo Ann Emerson (R-MO)
• Rep. Cathy McMorris-Rodgers (R-WA)
• Rep. Henry Waxman (D-CA), Ranking Member of the Energy and Commerce Committee
• Rep. Frank Pallone (D-NJ), Ranking Member, Energy and Commerce Health Subcommittee

• Sen. Sherrod Brown (D-OH)
• Sen. Roger Wicker (R-MS)
• Sen. Pat Toomey (R-PA)
• Sen. Tom Coburn (R-OK)
• Sen. Mike Crapo (R-ID)
• Sen. Joe Manchin (D-WV)
• Sen. Saxby Chambliss (R-GA)
• Sen. Scott Brown (R-MA)
• Sen. John Thune (R-SD)
• Sen. Richard Blumenthal (D-CT)
• Sen. John Barrasso (R-WY)
• Sen. Mike Lee (R-UT)

Thanks to Rep Young who sent a letter to the FTC this week!

NCPA Participates in CMS Meeting on NADAC Benchmark:

This week NCPA attended the CMS stakeholder meeting organized to discuss the development of the National Average Drug Acquisition Cost (NADAC) Survey that could be used by state Medicaid programs to set pharmacy reimbursement. The NADAC would be based on monthly invoices provided by a sample of community pharmacies. The meeting was held in Baltimore at CMS headquarters. Attendees included both state and national pharmacy associations, PBM’s, government agencies, buying groups, Bio-Tech companies amongst others. A summary of how NADAC will be calculated and potentially used by states is attached.

NCPA Submits Comments to OPM on PBM Transparency in Multi-State Exchange Plans:

NCPA submitted comments to the Federal Office of Personnel Management (OPM) regarding the need for PBM transparency in the multi-state plans in the state health insurance exchanges that will be administered by OPM. NCPA comments encouraged OPM to mirror the PBM transparency provisions that were included in the proposed HHS regulations to implement the individual state exchanges. NCPA comments also encouraged OPM to allow the participation of any willing pharmacy that accepts the terms of the contract and that has not been excluded from any state or federal program as well as urged OPM not to equate access to pharmacy services to access to mail order pharmacy.

HHS Releases Rules on Copay Waivers for Women’s Health Care Services:

HHS released a rule regarding co-pay waivers for preventive women’s health care services. Such cost sharing will be prohibited for non-grandfathered health plans starting with plan years beginning on or after August 1, 2012. This includes contraception and contraceptive counseling. Women will have access to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling. The regulation does not impact abortifacient drugs. Moreover, g rouphealth plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.

CMS Says No Medicare Part D Premium Increase in 2012:

This week CMS announced that Medicare average prescription drug premiums will not increase in 2012. CMS also announced that more people with Medicare are receiving discounts on prescription drug costs and no-cost preventive services. New data indicates that 17 million people with Medicare have received free preventive services this year while 900,000 Medicare beneficiaries who hit the prescription drug donut hole have received a 50 percent discount on their prescription drugs. CMS also announced that the cost of the average Medicare prescription drug plan premium in 2012 will be about $30. The average premium in 2011 is $30.76.

NCPA to Gov Cuomo: Please Sign Bill Eliminating Mandatory Mail Order:

NCPA sent a letter to New York Governor Andrew Cuomo (D), asking him to sign the bill that would prohibit the use of mandatory mail order programs in prescription drug programs in the state. The bill overwhelmingly passed the legislature several months ago, and is awaiting his signature.

NCPA Launches “Simplify My Meds” Program:

This “turnkey” program provides NCPA members with tools, training, and support to help them implement a coordinated refill program in their pharmacy. In addition to providing members with a business opportunity, NCPA would like to track not only pharmacy participation, but patient involvement. This will help illustrate patient progress and better understanding of their medication and better overall adherence as a result of their participation in this coordinated refill program. The results of these findings will be an important component of community pharmacy’s overall advocacy efforts as we continue to show pharmacy’s value in improving patient outcomes while decreasing health care costs.

Oklahoma Board Approves “Dispose My Meds”:

The Oklahoma Board of Pharmacy has recently approved NCPA’s Dispose My Meds program and plans a pilot program for the safe disposal of unused/unwanted/expired (UUE) medications in conjunction with the Association. The pilot program will allow Oklahoma in-state licensed pharmacies to establish a drop-off location in their pharmacy for UUE medications, and then dispose of them through the Disposemymeds.org program. NCPA will coordinate with the Board of Pharmacy on next steps.