Welcome to the 47 th Annual NCPA Legislative Conference
We must all hang together, or assuredly we shall all hang separately – Benjamin Franklin We have strength in numbers and must leverage that strength and speak with a coordinated and unified voice to deliver a pro-pharmacy, pro-patient message to achieve success. Within community pharmacy, our collective organizations represent thousands of stores, hundreds of thousands of employees and millions of patients. We can assemble a nationwide ground game second to none, leveraging our strengths to win!
Welcome to D.C.! - Political Lay of the Land House Republicans have the largest working majority since the Hoover administration in 1931 with 247 seats Senate Republicans need 6 Democrats to pass any legislation (60 vote threshold) Obama administration: Confrontation? Vetoes? Rulemaking and executive orders? Senate R’s need 13 Democrats to override Presidential veto 2016 Presidential race looming Since WWII only once has a political party won the White House in 3 consecutive elections
Community Pharmacy Lay of the Land Soaring generic price spikes and significant lags in PBM reimbursements Inability to participate in Medicare Part D Preferred Networks Despite being on the front lines of health care delivery, inability to be reimbursed Under Medicare Part B for services outlined in their state’s existing scope of practice
“Every strike brings me closer to the next home run” – Babe Ruth CMS Final Part D Rule for Contract Year 2015 Dropped “Any Willing Pharmacy” provision CMS will “respond to plan offerings that they determine to be discriminatory in its proposed availability and access to preferred cost sharing” Closely monitor beneficiaries’ access to preferred cost sharing as well as drug pricing by pharmacies offering preferred cost sharing, to determine whether future rulemaking in this area is necessary
2016 CMS Final Call Letter – Access to Preferred Cost Sharing Requires that information be published on preferred cost sharing levels for each plan (to provide greater transparency to beneficiaries) Require plans that CMS deems outliers – plans whose access to preferred pharmacies was in bottom 10 th percentile compared to all Part D plans serving rural, suburban or urban areas – to disclose in their 2016 marketing materials that their preferred network offers lower access If possible, will also show which plans have less convenient access to these pharmacies on Medicare plan finder, will continue to monitor access levels and take additional action
2016 CMS Final Call Letter – MAC Pricing Updates Effective January 1, 2016, MAC pricing is subject to the mandatory 7-day updating CMS “reminds” Part D sponsors that MAC updates must be provided to pharmacies “in a manner that is usable by pharmacies” so they can validate prices Part D sponsors must also disclose update MAC drug prices to pharmacies in advance of their use for reimbursement
2015 NCPA Membership Priorities Passing state and federal MAC bills to address delays in generic prescription payment rate updates “Any Willing Pharmacy” having access to Medicare Part D Preferred Networks Regulatory advocacy on new definitions of how Medicaid calculates its payments to pharmacies (i.e. NADAC) Pharmacist Provider Status Small business tax reform
2015 Legislative Conference Hill Lobbying Priorities Generic Drug Pricing Transparency and Timely Updates Fairness in Part D Preferred Pharmacy Networks Recognition as Provider in Medicare Part B
The MAC Transparency Act H.R. 244 Introduced in the House by Reps. Doug Collins (R-GA) and Dave Loebsack (D-IA) on January 9, 2015 The legislation would increase transparency of generic drug payment rates in Medicare Part D, the Federal Employees Health Benefits Program (FEHB) and TRICARE, by requiring PBM’s to: Provide pricing updates at least once every seven days Disclose the sources used to update MAC prices Notify pharmacies of any changes in individual drug prices in advance of reimbursement for claims Establish an appeals process to resolve disputes when drug prices are less than the acquisition cost of a drug Protect patient privacy and choice in Part D and FEHB by prohibiting a PBM from requiring that a beneficiary use a retail or mail order pharmacy in which the PBM has an ownership interest
Ensuring Seniors Access to Local Pharmacies Act H.R. 793/S. 1190 This bi-partisan “Any Willing Pharmacy” legislation would allow community pharmacies located in medically underserved areas (MUA’s), medically underserved populations (MUP’s) or health professional shortage areas (HPSA’s) to participate in Medicare Part D preferred pharmacy networks so long as they are willing to accept the contract terms and conditions that other in-network providers operate under H.R. 793 was introduced in the House by Reps. Morgan Griffith (R-VA) and Peter Welch (D-VT) on February 5, 2015 and currently has 38 co-sponsors S. 1190 was introduced in the Senate by Sens. Shelly Moore Capito (R-WV), Tom Cotton (R-AR), Joe Manchin (D-WV) and Sherrod Brown (D-OH) on May 5, 2015
Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status) H.R. 592/ S.314 This legislation would permit pharmacists in medically underserved communities to both provide and be reimbursed under Medicare Part B for services outlined in their state’s existing scope of practice The legislation is consistent with precedent established by the Nurse Practitioners (NP’s) and Physicians’ Assistants (PA’s) provider status efforts; pharmacist services would be reimbursed at 85% of the physician fee schedule H.R. 592 was introduced in the House by Reps. Brett Guthrie (R-KY), Todd Young (R-IN), G.K. Butterfield (D-NC) and Ron Kind (D-WI) and currently has 113 co-sponsors S. 314 was introduced by Sens. Chuck Grassley (R-IA), Sherrod Brown (D-OH), Mark Kirk (R-IL) and Bob Casey (D-PA) on January 29, 2015 and currently has 13 co-sponsors
Emerging Issues TRICARE Pilot Program – Preferred Networks 21 st Century Cures – Pharmacy Lock-in provision Compounding
Asks for House Visits Ask your member/staffer to co-sponsor H.R. 244, the MAC Transparency Act; thank them if they are already a co-sponsor Ask your member/staffer to co-sponsor H.R. 793, the Ensuring Seniors Access to Local Pharmacies Act (Any Willing Pharmacy); thank them if they are already a co- sponsor Ask your member/staffer to co-sponsor H.R. 592, the Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status); thank them if they are already a co-sponsor; provide MAC claims data
Asks for Senate Visits Ask your Senator/staffer to co-sponsor S.1190, the Ensuring Seniors Access to Local Pharmacies Act (Any Willing Pharmacy); thank them if they are already a co- sponsor Ask your Senator/staffer to co-sponsor S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act (Provider Status); thank them if they are already a co-sponsor Educate your Senator/staffer about everyday problems you are facing with soaring generic price spikes and significant lags in PBM reimbursements; see if they would be interested in introducing Senate companion legislation to H.R. 244, the MAC Transparency Act
Tips for a Successful Meeting Be prompt and flexible . If the member of Congress is unavailable or late, convey points to the staffer as if they were the member. Be yourself . No one knows your business or patients as well as you. Take the opportunity to convey real examples of how these issues impact your business and ability to adequately serve your patients on a daily basis. You are a constituent – don’t hesitate to ask the member for help in addressing problems impacting you and your patient base Be engaged . Distribute and collect business cards. Take notes during the meeting. Promptly follow up with a thank you to the member or staffer reiterating points you made in the meeting, and develop a relationship with them moving forward
“ Never, Never, Never give in”! – Winston Churchill
Contact Information Steve Pfister Senior Vice President, Government Affairs Phone: (703) 600-1184 steve.pfister@ncpanet.org
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