By Michael Rule, Associate Director of Grassroots and Public Affairs
From a grassroots perspective, 2013 should be a year that is long remembered by pharmacists. Due to pharmacist engagement, independent community pharmacists achieved pro-patient, pro-pharmacist successes at both the state and federal level and continued to build relationships with legislators through hosting pharmacy visits.
At the state level, five states passed legislation to provide a modicum of transparency in how pharmacies are reimbursed for generic dispensing. Additionally, eight states passed legislation to address audits by pharmacy benefit managers (PBMs) to ensure they are focused on uncovering cases of fraud and abuse rather than used to reverse legitimate claims to create a revenue stream for PBMs, now bringing the total number of states with fair pharmacy audit protections to 29. Furthermore, the state of Hawaii passed the strongest anti-mandatory mail order (AMMO) bill in the country.
While independent community pharmacists continued their momentum at the state level, they also made progress at the federal level, most notably with compounding and track and trace legislation. Earlier legislation proposed in response to the 2012 meningitis tragedy would have imposed FDA oversight over compounding and created burdensome reporting requirements for pharmacies that offer compounding services. Grassroots efforts by NCPA members prompted further deliberation and negotiations between the House and Senate in which NCPA was intimately involved. In the end, traditional compounding oversight remained under the purview of state boards of pharmacy rather than the FDA.
Through phone calls and emails, independent pharmacists also raised concerns to Congress and Medicare over exclusionary preferred networks. As a result, 19 United States Senators and 31 members of the House of Representatives sent letters to the Centers for Medicare and Medicaid Services (CMS) expressing concerns over these exclusionary networks and demanding to know what CMS was going to do to address the problems. In addition, some pharmacists weighed in directly with CMS.
CMS recently proposed a rule addressing Medicare Part D plans starting in 2015. Among other things, this rule proposes to allow any willing provider to offer “preferred cost sharing” in Part D plans. It would also expand medication therapy management (MTM) services and make these available to more Part D beneficiaries. Moreover, this proposed rule also addresses MAC issues and the need for PBMs to update their pricing on a more frequent basis. This proposed rule is open for public comment and we can assume the opponents of these proposals will be most vocal and do everything in their power to defeat them. Likewise it is important to pharmacists to make their voices heard and submit comments supporting CMS’ proposed changes. Stay tuned to NCPA member communications for updates and details on the process of commenting to CMS.
In addition, more states are debating MAC transparency legislation as well as PBM audit reform legislation and we will need you to remain engaged with your legislators. (NCPA is developing a tool kit of materials for your use and will advertise their availability in E-News in the coming weeks).
Independent community pharmacists should be proud of the progress made in 2013, but there is still much more to be done. Keep up the grassroots outreach and we can achieve more in 2014.