What did we spend the week in DC advocating for? Some of the most important issues facing our profession currently! NCPA currently represents the interests of 22,000 pharmacists across the country, and exponentially more patients whose best interests are in mind when creating legislative priorities. The 2 days on Capitol Hill advocated for the following:
- S 988/HR 803: Improving Transparency and Accuracy in Medicare Part D Spending Act. This piece of legislation currently has 1 senate and 9 House cosponsors and would prohibit retroactive DIR fees for Medicare Part D plans. DIR fees are direct and indirect renumeration fees. After a claim for a prescription is submitted by a pharmacy to the PBM (pharmacy benefit manager) that processes it for the insurance provider, we are given a rate of reimbursement almost immediately which allows us to go ahead and charge the patient a copay and dispense the medication. However, anywhere from 3-6 months later, the pharmacy’s bank account suddenly is hit with DIR fees, taken with no warning and no explanation by the PBM. In many cases, the pharmacy now has actually lost money on the claim, or at the very least sees a gross profit margin much lower than expected. But this money taken back by the PBM does not go to the patient as a reimbursement for their copay or premium payments. The money goes directly into the pockets of the PBM, which is why you now see ALL the top 3 PBMs (CVS/Caremark, Optum Rx, and Express Scripts) in the top 15 of the Fortune 500 list. Not only are the patients being overcharged for their prescriptions, but pharmacies are losing thousands of dollars each year. The average annual total of DIR fees is somewhere between $80-100,000, with many pharmacies seeing much higher. This is driving many of the independent pharmacies out of business, therefore plunging their communities into far worse health statuses. This law would not allow PBMs to take these fees months later, and instead require any fees be taken at the point of sale, therefore allowing the patient to experience a lower copay, and pharmacies be able to budget more effectively.
- HR 1035: Prescription Drug Price Transparency Act. This currently has 23 cosponsors and would require PBMs to be transparent about the maximum allowable cost (which translates to the amount they reimburse pharmacies for dispensing a drug) that they utilize for each plan and pharmacy. They currently reimburse different rates to different pharmacies and for specific medications made by manufacturers that offer them rebates. It would also outlaw PBM steering (a bill that was recently passed in Georgia), a practice in which a PBM like CVS/Caremark requires that beneficiaries go to a pharmacy that they own (CVS). This is a monopoly and takes away the patients’ ability to choose their location and level of care.
- HR 1959: Preserving Patient Access to Compounded Medications Act. This bill currently has 1 cosponsor and would require that the FDA acts to preserve the ability of patients to receive their compounded medications. This is a particular interest and passion of mine, and I look forward to continuing to advocate for it in May at the IACP Compounders on Capitol Hill event.
- Open Medicare Part D Preferred Networks to “Any Willing Pharmacy”. This is not yet a bill, but the idea is that Medicare Part D preferred networks would be open to any pharmacy that was willing to accept the contract terms and conditions would be able to participate. This would be Part D beneficiaries would have access to discounted copays at a pharmacy of their choice rather than only those currently in their exclusive preferred network.
- The Congressional Pharmacy Caucus. We urged all legislators to join this caucus (led by Representatives Peter Welch and Buddy Carter) to further their education on issues affecting community pharmacies and patients.
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