Advocacy in action: Pharmacists, trade groups focus on policy
Outside of delivering patient care, making the back of the store front of mind for lawmakers is increasingly the focus of pharmacists and retailers. More than any other part of the business, the pharmacy is at the mercy of legislators, and as a result, stakeholders are required to be advocates for the profession on the state and federal level.
Currently, pharmacy advocates and organizations are pushing for legislation that focuses on enabling pharmacies to deliver improved patient health. That focus has led to more states allowing more vaccines to be delivered by pharmacists and has been behind the perennial push to get pharmacists provider status under Medicare Part B as a way to properly reimburse them for services they provide, particularly in medically underserved areas. As that happens, two areas of the business, in particular, have come to fore — ensuring transparent reimbursements and fighting the opioid crisis.
Reimbursement matters
A growing obstacle that pharmacy owners and organizations point to are direct and indirect remuneration, or DIR, fees. These fees were recently the focus of a letter from 50 members of the House of Representatives to Health and Human Services Secretary Alex Azar. In the letter, the representatives suggested restructuring pharmacy price concessions to require all price concessions to be included in the negotiated price that a Medicare beneficiary pays at point of sale.
“The unpredictable variability in the use of fees provides little visibility for the Medicare program, as well as for participating retail pharmacies, particular for performance-based fees and the goals necessary to achieve specified targets to ‘earn back’ fee amounts,” the letter said. The letter, whose signatories were led by U.S. Reps. Tom Marina, R-Pa., and Dave Loebsack, D-Iowa, was praised by the National Association of Chain Drug Stores.
“NACDS is committed to helping bring about a solution to unsustainable DIR fee practices,” said Steve Anderson, president and CEO of NACDS. “We are hopeful that the Centers for Medicare and Medicaid Services will maintain the momentum
that it has signaled to move toward a workable solution.”
For the time being, CMS has not restructured DIR fees in its most recent final rule, noting that new requirements would be proposed through notice and comment rulemaking. PBM organizations have said that DIR fees help lower the costs of Medicare programs for beneficiaries. “Without DIR, Part D premiums and program costs would be much higher,” said Mark Merritt, president and CEO of the Pharmaceutical Care Management Association.
Outside of Medicare, though, pharmacies deal with retroactive fees that many on the state level have worked to keep more transparent. Recently signed legislation in Florida, H.B. 351, focused on maximum allowable costs, requiring PBMs operating in the Sunshine State to register and update their MAC prices every seven days.
For Eric Larson, who owns and operates Prescriptions Unlimited in St. Cloud, Fla., the lack of transparency made operating his business more difficult. “It’s hard for us to operate month to month,” Larson said.
His sentiment was echoed by the National Community Pharmacists Association’s director of state government affairs Matt Magner. “You can’t really plan for business if you don’t know how much you’re going to be giving back to the PBM,” Magner said, adding that such legislation as in Florida is designed to provide some transparency to help pharmacies plan. “It still allows the fees to be charged, but it’ll give the pharmacy some notice of how much it’s going to be paying.”
Similar legislation has been taken up in such states as Hawaii and Maryland, with NCPA lending an assist to help pharmacy advocates bolster the laws.
In addition to the MAC transparency measure, the Florida legislation included language preventing a so-called “gag rule” for pharmacists, noting that contracts between health insurers and PBMs cannot prevent a pharmacist from telling a patient when a cost-sharing obligation is higher than the retail price. Federal legislation was recently introduced by a group of lawmakers that included Rep. Buddy Carter, R-Ga. — himself a pharmacist — that would do away with such gag rules nationally.
Fighting opioid abuse
As pharmacies work to manage their businesses, they also are on the front lines of the opioid crisis. Lawmakers have begun taking up legislation that is aimed at helping curb abuse and misuse of prescription drugs through e-prescribing medication disposal.
Ahead of the Drug Enforcement Administration’s National Prescription Drug Take-Back Day, four members of the House of Representatives introduced H.R. 5628, the Access to Increased Drug Disposal Act — a companion to similar legislation introduced in the Senate by Sens. Joni Ernst, R-Iowa, and Chuck Schumer, D-N.Y. The bills would create a program to provide state funding for such drug disposal efforts as disposal kiosks and staff training based on eligible collector participation rates and opioid overdose rates.
“Through the provision of federal funding to operate take-back kiosks in various communities, the act encourages more pharmacies to volunteer to host take-back kiosks,” NACDS’ Anderson said. “Passage of the act would be a key component of a broader and more diversified effort to assist consumers with safely and effectively disposing of their unwanted prescription drugs.”
NACDS, which has praised the disposal bills, also has been keeping tabs on legislation focused on e-prescribing controlled substances — the Every Prescription Conveyed Securely Act — that was advanced by the House Energy and Commerce Committee’s Subcommittee on Health in late April. NACDS said that a Morning Consult poll conducted in January found 76% of respondents supported requirements that all prescriptions be handled electronically.
Both NACDS and NCPA have encouraged the expansion of prescription drug monitoring programs to monitor opioid prescriptions. The MONITOR Act, introduced in November 2017 by Rep. Brian Fitzpatrick, R-Pa., would incentivize states to have a PDMP that meets minimum reporting standards and require pharmacies to report a dispensed controlled substance within one business day, while meeting standards for interoperability between states.
Grassroots focus
As the industry approached legislation, the key is maintaining a grassroots network of built-in advocates — that is pharmacists themselves.
“We have to be advocates — I don’t see any other way,” Prescriptions Unlimited’s Larson said. “Health care changes so quickly that we have to stay in front of it, and part of staying ahead of it is getting out there and letting legislators know what we do.”
Larson is part of both the Florida Pharmacy Association’s government affairs committee and the McKesson Independent Advisory Board. Larson’s experience highlights the role pharmacy companies and organizations play in helping mobilize pharmacist support for legislation that can positively impact pharmacies and patients. “If we care about our patients and our profession, we should be working toward enhancing our services and being able to maintain our level of care and provide more care,” he said.
Associations play a key role in rallying pharmacy advocates every year. This year, NACDS’ RxImpact Day on Capitol Hill, in its 10th iteration, saw record numbers and brought pharmacy advocates from all 50 states to discuss the importance of pharmacy with every member of Congress. Similarly, NCPA convened its 2018 Congressional Pharmacy Summit. NCPA’s event drew pharmacists from 37 states who visited more than 250 congressional offices.
At the NACDS Annual Meeting, Anderson highlighted the organization’s Access Agenda, which focuses on policy solutions that he said are “consistently pro-patient and pro-pharmacy.” The victories pharmacy has won, he said, has bee
Currently, pharmacy advocates and organizations are pushing for legislation that focuses on enabling pharmacies to deliver improved patient health. That focus has led to more states allowing more vaccines to be delivered by pharmacists and has been behind the perennial push to get pharmacists provider status under Medicare Part B as a way to properly reimburse them for services they provide, particularly in medically underserved areas. As that happens, two areas of the business, in particular, have come to fore — ensuring transparent reimbursements and fighting the opioid crisis.
Reimbursement matters
A growing obstacle that pharmacy owners and organizations point to are direct and indirect remuneration, or DIR, fees. These fees were recently the focus of a letter from 50 members of the House of Representatives to Health and Human Services Secretary Alex Azar. In the letter, the representatives suggested restructuring pharmacy price concessions to require all price concessions to be included in the negotiated price that a Medicare beneficiary pays at point of sale.
“The unpredictable variability in the use of fees provides little visibility for the Medicare program, as well as for participating retail pharmacies, particular for performance-based fees and the goals necessary to achieve specified targets to ‘earn back’ fee amounts,” the letter said. The letter, whose signatories were led by U.S. Reps. Tom Marina, R-Pa., and Dave Loebsack, D-Iowa, was praised by the National Association of Chain Drug Stores.
“NACDS is committed to helping bring about a solution to unsustainable DIR fee practices,” said Steve Anderson, president and CEO of NACDS. “We are hopeful that the Centers for Medicare and Medicaid Services will maintain the momentum
that it has signaled to move toward a workable solution.”
For the time being, CMS has not restructured DIR fees in its most recent final rule, noting that new requirements would be proposed through notice and comment rulemaking. PBM organizations have said that DIR fees help lower the costs of Medicare programs for beneficiaries. “Without DIR, Part D premiums and program costs would be much higher,” said Mark Merritt, president and CEO of the Pharmaceutical Care Management Association.
Outside of Medicare, though, pharmacies deal with retroactive fees that many on the state level have worked to keep more transparent. Recently signed legislation in Florida, H.B. 351, focused on maximum allowable costs, requiring PBMs operating in the Sunshine State to register and update their MAC prices every seven days.
For Eric Larson, who owns and operates Prescriptions Unlimited in St. Cloud, Fla., the lack of transparency made operating his business more difficult. “It’s hard for us to operate month to month,” Larson said.
His sentiment was echoed by the National Community Pharmacists Association’s director of state government affairs Matt Magner. “You can’t really plan for business if you don’t know how much you’re going to be giving back to the PBM,” Magner said, adding that such legislation as in Florida is designed to provide some transparency to help pharmacies plan. “It still allows the fees to be charged, but it’ll give the pharmacy some notice of how much it’s going to be paying.”
Similar legislation has been taken up in such states as Hawaii and Maryland, with NCPA lending an assist to help pharmacy advocates bolster the laws.
In addition to the MAC transparency measure, the Florida legislation included language preventing a so-called “gag rule” for pharmacists, noting that contracts between health insurers and PBMs cannot prevent a pharmacist from telling a patient when a cost-sharing obligation is higher than the retail price. Federal legislation was recently introduced by a group of lawmakers that included Rep. Buddy Carter, R-Ga. — himself a pharmacist — that would do away with such gag rules nationally.
Fighting opioid abuse
As pharmacies work to manage their businesses, they also are on the front lines of the opioid crisis. Lawmakers have begun taking up legislation that is aimed at helping curb abuse and misuse of prescription drugs through e-prescribing medication disposal.
Ahead of the Drug Enforcement Administration’s National Prescription Drug Take-Back Day, four members of the House of Representatives introduced H.R. 5628, the Access to Increased Drug Disposal Act — a companion to similar legislation introduced in the Senate by Sens. Joni Ernst, R-Iowa, and Chuck Schumer, D-N.Y. The bills would create a program to provide state funding for such drug disposal efforts as disposal kiosks and staff training based on eligible collector participation rates and opioid overdose rates.
“Through the provision of federal funding to operate take-back kiosks in various communities, the act encourages more pharmacies to volunteer to host take-back kiosks,” NACDS’ Anderson said. “Passage of the act would be a key component of a broader and more diversified effort to assist consumers with safely and effectively disposing of their unwanted prescription drugs.”
NACDS, which has praised the disposal bills, also has been keeping tabs on legislation focused on e-prescribing controlled substances — the Every Prescription Conveyed Securely Act — that was advanced by the House Energy and Commerce Committee’s Subcommittee on Health in late April. NACDS said that a Morning Consult poll conducted in January found 76% of respondents supported requirements that all prescriptions be handled electronically.
Both NACDS and NCPA have encouraged the expansion of prescription drug monitoring programs to monitor opioid prescriptions. The MONITOR Act, introduced in November 2017 by Rep. Brian Fitzpatrick, R-Pa., would incentivize states to have a PDMP that meets minimum reporting standards and require pharmacies to report a dispensed controlled substance within one business day, while meeting standards for interoperability between states.
Grassroots focus
As the industry approached legislation, the key is maintaining a grassroots network of built-in advocates — that is pharmacists themselves.
“We have to be advocates — I don’t see any other way,” Prescriptions Unlimited’s Larson said. “Health care changes so quickly that we have to stay in front of it, and part of staying ahead of it is getting out there and letting legislators know what we do.”
Larson is part of both the Florida Pharmacy Association’s government affairs committee and the McKesson Independent Advisory Board. Larson’s experience highlights the role pharmacy companies and organizations play in helping mobilize pharmacist support for legislation that can positively impact pharmacies and patients. “If we care about our patients and our profession, we should be working toward enhancing our services and being able to maintain our level of care and provide more care,” he said.
Associations play a key role in rallying pharmacy advocates every year. This year, NACDS’ RxImpact Day on Capitol Hill, in its 10th iteration, saw record numbers and brought pharmacy advocates from all 50 states to discuss the importance of pharmacy with every member of Congress. Similarly, NCPA convened its 2018 Congressional Pharmacy Summit. NCPA’s event drew pharmacists from 37 states who visited more than 250 congressional offices.
At the NACDS Annual Meeting, Anderson highlighted the organization’s Access Agenda, which focuses on policy solutions that he said are “consistently pro-patient and pro-pharmacy.” The victories pharmacy has won, he said, has bee