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Pharmacy Agenda

Men Talking at a Pharmacy 

Support Pharmacy Competition in Medicare Part D and urge Congress to Pass H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act of 2014

This bipartisan legislation was introduced by Reps. Morgan Griffith (R-VA) and Peter Welch (D-VT) and it would allow independent pharmacies to at least try and participate in preferred pharmacy networks in Part D. Specifically the bill would allow any pharmacy that is located in a health professional shortage area or a medically underserved to participate in the networks if they can meet comparable terms and conditions that other in-network providers have operated under in the past.

Preferred pharmacy networks have been contemplated within the Medicare Part D program since 2006. However, it wasn’t until more recently that plans implemented preferred networks. In 2013, there were several large national Part D plans that featured preferred pharmacy networks, and they have continued to grow in 2014.

In January, the Centers for Medicare & Medicaid Services (CMS) released an expansive rule that spoke to the inadequacies that exist within these networks.

These networks were created under the noble guise of fostering fair competition and saving the federal government money. In the proposed rule CMS questions whether or not these networks are actually saving money for the government and proposed to allow any pharmacy willing to accept a contract's terms and conditions to offer a preferred cost sharing level.

Support MAC Transparency and Urge Congress to Pass H.R. 4437, the Generic Drug Pricing Fairness Act of 2014

H.R. 4437 is a bipartisan bill introduced by Representatives Doug Collins (R-GA-09) and Dave Loebsack (D-IA-02) that would bring greater transparency to Medicare Part D generic drug payments.

Generic prescription drugs account for approximately 80 percent of drugs dispensed, but the reimbursement system for these medications is a mystery to pharmacists and raises serious questions as to whether Medicare is overpaying the drug plan middlemen, pharmacy benefit managers (PBMs). The contracts independent community pharmacies sign with PBMs for access to their pharmacy networks are non-negotiable and do not disclose the terms and conditions regarding payments for most generic drugs.

Even though pharmacists are reimbursed for generics via Maximum Allowable Cost (MAC) lists, these lists are not updated on a regular basis which frequently results in pharmacists being reimbursed below their acquisition cost for various medications particularly in today’s pharmaceutical marketplace which has been plagued with a series of generic price spikes.

Support H.R. 4190 to Recognize Pharmacists as Providers Under Medicare Part B

H.R. 4190 is a bipartisan bill introduced by Representatives Brett Guthrie (R-KY-2), Todd C. Young (R-IN-9), and G.K. Butterfield (D-NC-1) that provides for coverage of pharmacists as providers and reimbursement for pharmacist services for Medicare beneficiaries under Part B.

Millions of Americans lack adequate access to primary health care because of primary care physician shortages in their communities, despite many of these patients having health insurance coverage. With an additional 36 million individuals potentially gaining health coverage under the Patient Protection and Affordable Care Act (PPACA), according to Congressional Budget Office (CBO) estimates, the physician shortages will only be exacerbated. The Association of American Medical Colleges has projected that there will be more than 91,000 fewer doctors than needed to meet demand by 2020.

Pharmacists are capable of playing a greater role in the delivery of health care services. Pharmacists who utilize their education, training, and license can provide services that include health and wellness screenings, managing chronic diseases, administering immunizations, medication management, and working in and partnering with hospitals and health systems to advance health and wellness and helping to reduce hospital readmissions. 

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