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Pharmacy Agenda

Men Talking at a Pharmacy 

 Support Competition, Consumer Choice and Integrity in Pharmacy Benefits

Policymakers should consider legislation that would result in:
1) greater choice of pharmacies for consumers;
2) greater transparency to Medicare and for pharmacies regarding generic drug payment rates;
3) fair standards for PBM pharmacy audits to assure that any recoveries are returned to Medicare and not kept by the PBMs.


Support Medicare Beneficiaries Access to DTS from Small Pharmacies

New cuts to pharmacy payment rates for diabetes testing supplies (DTS) will likely force most small and long-term care pharmacies out of the program, meaning that Medicare beneficiaries that want to use their neighborhood pharmacy will have to use mail order or travel long distances to obtain these vital products. Members of Congress in both chambers and both parties should correct this provision before patients lose access to their pharmacy of choice.


Expand Role of Pharmacists in Patient Care

Pharmacists help improve prescription medication use and improve public health by providing counseling, medication therapy management programs, and immunizations. They can also improve quality and reduce medication costs through participation in new patient care delivery models such as Accountable Care Organizations, transition of care models, and chronic care management programs. Policymakers should consider expanding these pharmacist patient care services by designating pharmacists as Medicare Part B providers.

Do you have questions? Call NCPA’s government affairs department at (703) 683-8200.

Find Your Legislators

Featured Alert

Tell Your Senators to Support Pro-Small Business and Pro-Patient Initiatives

Uege your Senators to support the following:

• Protect Pharmacy Compounding. Pharmacy compounding of medications is an important part of medical care that allows for the dispensing of custom-made medications and should continue to be regulated by state Boards of Pharmacy, as all other medical licensed professional practices are. Please work to protect independent pharmacy compounding and patient access to these customized medications.

• S. 557, bipartisan legislation that would expand medication therapy management services provided by independent community pharmacies under Medicare Part D. Expanded MTM services for Medicare Part D beneficiaries promotes medication adherence, promotes better health care outcomes and generates long term savings through avoidable hospitalizations and costly medical interventions.

• A Senate companion bill to H.R 1188, the Preserving Our Hometown Independent Pharmacies Act of 2013, bipartisan House legislation which would allow independent pharmacies to better serve their patients by pushing back against insurance companies that want to push more patients to mail order rather than allowing them to use their neighborhood pharmacy.

• S. 867, the Medicare Prescription Drug Program Integrity and Transparency Act of 2013 introduced this past Monday by Senators Pryor (D-AR) and Moran (R-KS ). This legislation sets standards for PBM audits under Part D and sets requirements for transparency on how maximum allowable costs (MACs) are set by PBMs and how they determine which medications are put on a MAC list. The Centers for Medicare and Medicaid services (CMS) recognized the abusive nature of PBM audits by stating in its call letter for 2014 recognized that PBMs are recouping substantial sums from community pharmacies over trivial clerical issues rather than targeting true fraud. When a pharmacist dispenses the right drug to the right patient for the correct cost, it should not be recouped in full. Additionally, PBMs refuse to disclose basic contract terms regarding MACs, including how reimbursements are determined, how often the MAC lists are updated, and even the criteria used to place a medication on a MAC list. Simple transparency ensures fair reimbursements and prevents plan sponsors that PBMs work for from being overcharged.

• Finally, I urge you to support a fix to the fiscal cliff legislation passed in January that greatly reduced pharmacy reimbursements for diabetes test strips dispensed by community pharmacies as of July 1. Also, pharmacies are prohibited from delivering these supplies to homebound patients and patients in long term care or assisted living facilities. Without a fix, patients will lose access to pharmacies of their choice and the face to face counseling pharmacists provide.


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Tell Your Representative to Support Pro-Small Business and Pro-Patient Initiatives

Urge your members of Congress to support the following:

• H.R. 1024, bipartisan legislation that would expand medication therapy management services provided by independent community pharmacies under Medicare Part D. Expanded MTM services for Medicare Part D beneficiaries promotes medication adherence, promotes better health care outcomes and generates long term savings through avoidable hospitalizations and costly medical interventions.

• H.R 1188, the Preserving Our Hometown Independent Pharmacies Act of 2013, bipartisan legislation which would allow independent pharmacies to better serve their patients by pushing back against insurance companies that want to push more patients to mail order rather than allowing them to use their neighborhood pharmacy.

• A PBM audit reform bill and requirements for transparency on how maximum allowable costs (MACs) are set by PBMs and how they determine which medications are put on a MAC list. The Centers for Medicare and Medicaid services (CMS) recognized the abusive nature of PBM audits by stating in its call letter for 2014 recognized that PBMs are recouping substantial sums from community pharmacies over trivial clerical issues rather than targeting true fraud. When a pharmacist dispenses the right drug to the right patient for the correct cost, it should not be recouped in full. Additionally, PBMs refuse to disclose basic contract terms regarding MACs, including how reimbursements are determined, how often the MAC lists are updated, and even the criteria used to place a medication on a MAC list. Simple transparency ensures fair reimbursements and prevents plan sponsors that PBMs work for from being overcharged.

• Finally, I urge you to support a fix to the fiscal cliff legislation passed in January that greatly reduced pharmacy reimbursements for diabetes test strips dispensed by community pharmacies as of July 1. Also, pharmacies are prohibited from delivering these supplies to homebound patients and patients in long term care or assisted living facilities. Without a fix, patients will lose access to pharmacies of their choice and the face to face counseling pharmacists provide.
View full details

Click here to Take Action!