NCPA Advocacy Center Update Week Ending October 25, 2014



Legislative Wrap Up from NCPA Annual Conference:  NCPA’s Annual Conference and Trade Show concluded this week in Austin, Texas.  NCPA remains focused on allowing any willing pharmacy to participate in Medicare Part D preferred pharmacy networks as well as ensuring timely updates to generic drug reimbursements. Uncertainty over which party will control the Senate come January and major legislative priorities faced by Congress during the lame-duck session could mean these and other priority issues have to wait until a new congressional session starts in January. Hopefully, Congress will hold hearings on generic drug pricing during the lame duck session. The hearings are a real possibility, as Sen. Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-MD) recently sent a letter to HHS Secretary Sylvia Mathews Burwell asking what steps HHS is taking to address the issue. The two lawmakers also sent letters to 14 generic drug manufacturers giving them until Oct. 23 to answer questions justifying the price increases.
NCPA Member Resources Available to Assist Members as Open Season for Medicare Part D Underway:  NCPA has created several resources for NCPA members to familiarize themselves with those Medicare Part D drug plans that are expected to enroll the largest number of beneficiaries in 2015. Pharmacists are encouraged to use these documents to help patients during the Oct. 15-Dec. 7 Annual Enrollment Period, when patients can switch or join plans.  The resources include a Part D Evaluation Tool and a Quick Reference Guide. These documents are intended for pharmacy staff use only and should not be distributed publicly to beneficiaries or others outside your organization.
NCPA Submits Comments to CMS Related to Transparent PBM Reporting of Part D Pharmacy Price Concessions:  NCPA’s comments are in response to CMS’ Proposed Guidance on Direct and Indirect Remuneration (DIR) and Pharmacy Price Concessions.  NCPA strongly supports CMS’ revised definition of “negotiated prices” in the Medicare Part D program, as we agree with CMS that some Part D sponsors have manipulated the DIR reporting mechanism by reporting many pharmacy price concessions as DIR under the guise that these price concessions could not be determined at point of sale.  This can lead to CMS and the plan’s enrollees paying higher monthly premiums and cost-sharing. NCPA has long argued that PBMs characterize pharmacy price concessions in many different self-imposed ways primarily often via their manuals or contract addenda unilaterally imposed on pharmacies. If such amounts are not truly payments for services but price concessions, Medicare Part D plans should be deducting such amounts at the point of sale resulting in lower plan costs  and beneficiary cost-sharing regardless of the term a PBM gives to such a concession.
CMS Seeks Info on Pharmacy Innovations in Medicare Parts C&D and Medicaid Managed Care:  The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is responsible for developing and testing new payment and service delivery models. As part of this effort, the CMS Innovation Center is interested in exploring opportunities to test innovations in stand-alone Medicare Prescription Drug Plans (PDP), Medicare Advantage (MA) and Medicare Advantage Prescription Drug Plans (MA-PD), Medicaid managed care plans (Medicaid plans), Medigap plans, and Retiree Supplemental health plans. NCPA will be commenting on behalf of independent pharmacy and the positive outcomes achieved by community pharmacist interactions.  A copy of the request can be found here.
MedPAC Meets to Discuss Part D Risk Sharing and Opioid Abuse:  On October 9, the Medicare Payment Advisory Commission (MedPAC) met to discuss how Medicare shares financial risk with Part D prescription drug plans and, with a decade of experience and a robust set of planofferings, whether Part D’s risk sharing mechanisms are still structured in a way that makes sense to beneficiaries and taxpayers. In every year since Part D began, 75% of plan sponsors had to make payments back to Medicare totaling roughly $1 billion each year. TheCommission will consider risk sharing in 2014-15, and may consider reform options. Commissioners also received a report on the potentially inappropriateuse of opioid pain medication, and the growth of opioid use since 2011. The report focused on some public and private measures to curb opioid use such as state prescription drug monitoring programs,pharmacy checklists, or provider or pharmacy “lock-in” programs toreduce doctor shopping. No formal recommendations were proposed at themeeting as commissioners sought seeking further information on how toaddress opioid abuse.
Painkiller Deaths Drop for First Time since 1999:  USA Today recently featured an article that highlights the decrease in prescription painkiller deaths according to new CDC data.  In 2012, the latest year available, deaths from prescription painkillers dropped 5% to 16,007, according to CDC data. Deaths from all categories of prescription drugs dropped 3%, the data shows. The new data show promising signs on reducing prescription drug deaths, however, drug poisoning deaths involving heroin in 2012 increased 35 percent to 5,927 from 4,397 in 2011.