2022 NCPA Annual Report
NCPA is the country’s leading advocate for America’s community pharmacy owners. NCPA represents over 19,400 pharmacies that employ over 240,000 individuals nationwide. Independent pharmacy is a $78.5 billion marketplace.
The 2022 NCPA Annual Report reviews the organization’s efforts and activities on behalf of extraordinary healthcare professionals during an extraordinary year.
Below is a comprehensive review of NCPA’s advocacy efforts on behalf of America’s independent community pharmacists over the past year. We represent our members before Congress, in the regulatory arena, in the courts, and in the states.
Our work is enhanced by the grassroots efforts of NCPA members, the NCPA Legislative/Legal Defense Fund, and the NCPA Political Action Committee. The NCPA Advocacy Center works to advance policies and solutions that are pro-patient, pro-pharmacy, and pro-small business.
Paxlovid Prescribing Authority: After months of advocacy from NCPA and other pharmacy organizations, the FDA revised the EUA for Paxlovid, authorizing state-licensed pharmacists to prescribe Paxlovid. This action allows pharmacists to prescribe Paxlovid to eligible patients with certain limitations as described in the FDA press release. Read the FDA press release here.
Extension of PREP Act Flexibilities: NCPA joined 92 patient, public health, and state and national pharmacy groups in a letter asking the Biden administration for formal clarification from HHS on potential expiration of pharmacy personnel flexibilities granted during the pandemic. The letter asks that PREP Act authorities remain in place through Oct. 1, 2024. Read the letter here.
Additional Funds for COVID-19 Uninsured Relief Fund: NCPA joined with 66 patient, provider, retail, and public health organizations in a letter to Senate and House leadership urging that they replenish the fund quickly. HRSA stopped processing claims for testing and treatment on March 22 and stopped accepting vaccination claims on April 5.
Test and Treat: NCPA joined thirteen other national pharmacy organizations on a letter to President Biden (D) regarding his “test and treat” announcement. The organizations applauded the President for recognizing the opportunity pharmacies present in expanding access to oral antivirals but highlighted that only a few pharmacy locations are currently eligible. The pharmacy organizations called on the FDA to modify its EUA and remove the limitations on pharmacists from ordering these medications.
Dismal Antivirals Reimbursements: NCPA CEO Douglas Hoey sent a letter to CMS Administrator Chiquita Brooks-LaSure, asking for immediate intervention before independent pharmacies are forced to stop dispensing the oral antiviral drugs because they can’t justify the cost to their business. In the letter, Hoey told the administration that fees paid to pharmacies range from $10.50 on the high end, still far below the pharmacists’ cost of dispensing, all the way down to $1.
CMS Vaccination Mandate: A CMS vaccine mandate resource is now available on the NCPA website. The white paper, authored by NCPA and Brown & Fortunato law firm, is titled “Update on CMS Vaccination IFR.” The white paper provides detailed information on who is covered by the vaccine mandate, compliance deadlines, the CMS requirements, and records that need to be kept.
PCMA fails to appeal 8th Circuit decision in PCMA v. Wehbi: In July, PCMA chose not to appeal to the Supreme Court the 8th Circuit decision upholding certain North Dakota laws regulating PBMs. The decision of the 8th Circuit that held that ERISA does not preempt North Dakota’s laws, and held that Medicare Part D only preempts a State law where that law overlaps with a specific Part D standard is now the law of the land for North Dakota, South Dakota, Nebraska, Minnesota, Iowa, Missouri, and Arkansas.
NCPA files an amicus brief in PCMA v. Mulready: NCPA, along with industry partners filed an amicus brief in support of the State of Oklahoma’s efforts to regulate PBMs. PCMA backed away from its broad challenge and is now challenging only four provisions related to network adequacy. Oral arguments are set for January 2023.
CMS disapproves Washington’s State Plan Amendment: NCPA, NACDS, and the Washington State Pharmacy Association filed a suit to challenge CMS’s original approval, and on remand from the Court, CMS changed course and disapproved the SPA. Washington has appealed the CMS decision to the 9th Circuit and the parties are actively engaged in mediation to settle the matter.
FTC visits with independent community pharmacy: FTC Chair Lina Khan sat for a fireside chat with NCPA CEO Doug Hoey. The two discussed the FTC’s role in regulating anticompetitive activity of PBMs. Chair Khan met with NCPA members in a follow-on meeting to discuss specific issues related to PBM anticompetitive conduct. FTC Commissioner Bedoya hosted a roundtable of independent community pharmacists and transparent PBMs to discuss conduct coming from Insurers and their affiliated PBMs and pharmacies.
PBM Transparency Act: With NCPA leading the charge, NCPA and 206 other pharmacy, consumer, patient, and business organizations sent a letter to Sens. Maria Cantwell (D-Wash.) and Charles Grassley (R-Iowa) to voice strong support for S. 4293, the PBM Transparency Act. Several patient groups, including the Association for Mature American Citizens, Free2Care Coalition, Global Healthy Living Foundation, National Consumers League, The AIDS Institute and National Grange, were among the signatories.
TRICARE: NCPA developed materials for members regarding the changes to the TRICARE pharmacy network made by ESI, including materials to engage patients to voice their complaints to TRICARE. Additionally, NCPA worked with the offices of Sen. Tom Cotton (R-Ark.) and Buddy Carter (R-Ga.) on a bicameral sign on letter to TRICARE demanding answers on how these changes came about and what oversight TRICARE is exercising over them. Additionally, NCPA is engaging veteran organizations on the issue.
Inflation Reduction Act: President Biden signed the Inflation Reduction Act, which delivers a significant legislative victory for Democrats. NCPA was represented at the bill signing by former NCPA Presidents Michele Belcher and Bob Greenwood.
Opposing Proposed Tax Increases: In January, NCPA joined more than 80 other business organizations on a letter to House and Senate leadership urging them to end efforts to pass massive tax increases in the Build Back Better Act. Instead, the signatories urge leadership to focus on alleviating current challenges, including inflation, labor shortages, and supply chain constraints.
FDA Commissioner: The Senate confirmed Dr. Robert Califf to return to the FDA as Commissioner. Prior to his confirmation, NCPA joined other pharmacy stakeholders in a letter of support.
340B: NCPA reconstituted the internal Task Force to discuss ongoing policy issues as well as engaging other stakeholders to discuss the implications of potential legislative and policy solutions to the stalemate and the impacts on community pharmacies. NCPA has reached out to the association representing FQHCs to engage and find opportunities to work together on educating members participating in arrangements with those covered entities. Additionally, NCPA continues to monitor decisions in legal matters as Courts make determination on the actions of pharmaceutical manufacturers and HRSA.
NCPA Highlights Changes Required to Make DIR Proposal Workable: NCPA submitted comments to CMS on the proposed DIR Rule which included several recommendations required to make the rule workable. Among its recommendations, NCPA noted that CMS must close the coverage gap loophole, ensure transparency of pharmacy reimbursements at point of sale, and address the effects of the rule on pharmacy cash flow.
- 2,700+ pharmacists submitted comments through NCPA’s grassroots portal
- Small Business Administration submitted their own letter to CMS in support of many of the issues NCPA raised in our comments
- 30 U.S. Senators sent a letter to CMS in support of proposed rule
- 85 members of the House of Representatives sent a letter to HHS in support of proposed rule. Additionally, Rep. Lisa Blunt Rochester (D-Del.) sent her own letter echoing support for the proposed rule.
- 232 organizations, signing onto the support letter to HHS in support of proposed rule
NCPA Advocacy Fought for Independents
In a letter led by Reps. Buddy Carter (R-Ga.) and Mike Rogers (R-Ala.), the incoming Chairman of the House Armed Services Committee, 49 members of Congress requested DOD participate in a listening session with stakeholders on Dec. 7 so they can fully understand the ramifications of their decisions.
Sen. Jon Tester (D-Mont.), Chairman of the Senate Committee on Veterans’ Affairs, sent a letter to the Department of Defense blasting TRICARE changes that threaten beneficiaries’ access to community pharmacies, especially in rural areas.
100 bipartisan Members of the House and Senate sent another letter to DOD led by Sen. Tom Cotton (R-Ark.) and Rep. Buddy Carter (R-Ga.) asking for answers about Express Scripts stripping local pharmacy access away from TRICARE families.
Senate Commerce Committee Advances S. 4293: The Senate Commerce, Science & Transportation Committee advanced S. 4293, the Pharmacy Benefit Manager Transparency Act of 2022. This bill was introduced by Sens. Maria Cantwell (D-Wash.) and Chuck Grassley (R-Iowa) and was approved on a 19-9 vote. The bill now heads to the full Senate, but timing is undetermined on when the Senate may take it up.
Rep. Mike Johnson (R-La.) sent a letter to the Department of Defense citing concerns about Express Scripts stripping local pharmacy access away from TRICARE families, especially in the areas surrounding Barksdale Air Force Base and Fort Polk in north Louisiana.
Senate Hearing Focuses on Abusive PBM Business Practices: U.S. Senate Commerce Committee held a hearing titled “Ensuring Fairness and Transparency in the Market for Prescription Drugs.” NCPA submitted a statement for the record calling for greater transparency and reform for PBMs.
Congressional Champions Send Letter to OMB Urging Prompt Action on Part D Rule: Reps. Peter Welch (D-Vt.), Morgan Griffith (R-Va.), Vicente Gonzalez (D-Texas), Buddy Carter (R-Ga.), Raja Krishnamoorthi (D-Ill.), John Rose (R-Tenn.), Abigail Spanberger (D-Va.), and Diana Harshbarger (R-Tenn.), as well as Senators Sherrod Brown (D-Ohio), Shelley Moore Capito (R-W.Va.), Jon Tester (D-Mont.), and James Lankford (R-Okla.), sent letters urging the White House Office of Management and Budget to finalize DIR rule.
Senators Seek Clarity for Pharmacists as Regulatory Flexibilities Wind Down: Sens. Charles Grassley (R-Iowa), Robert Casey (D-Pa.), Sherrod Brown (D-Ohio), John Barrasso (R-Wyo.) and Ben Ray Luján (D-N.M.) sent a letter to CMS seeking clarification on the flexibilities that will be granted to pharmacists once the COVID-19 public health emergency designation ends.
Senate Finance Committee Holds Drug Pricing Hearing: The Senate Committee on Finance held a hearing titled “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare”. NCPA submitted a statement for the record highlighting the Biden administration’s proposed rule to end retroactive pharmacy DIR fees and needed tweaks to the proposal, as well as advocating for the end of spread pricing in Medicaid Managed Care.
Senator Grassley Urges the FTC to Move Ahead with PBM Study: Senator Charles Grassley (R-Iowa) sent a letter to FTC Chairwoman Lina Khan urging the FTC to move ahead with a 6(b) study on PBMs. NCPA has worked with Senator Grassley for several years on his FTC study bill. The most current version is S. 1388, the Prescription Pricing for the People Act.
Federal Legislation Introduced to Expand Access to Pharmacists Services: Reps. Ron Kind (D-Wisc.), David B. McKinley (R-W.Va.), Nanette Diaz Barragán (D-Calif.), and Buddy Carter (R-Ga.) introduced the Equitable Community Access to Pharmacist Services Act. This legislation will help ensure patients can continue to access COVID-19 pandemic and pandemic-related health services from pharmacists and provide payments for these services. It would provide coverage for pharmacist services under Medicare Part B for COVID and flu vaccines; COVID, flu, strep and RSV testing; and COVID, flu and strep treatment. Legislation can be found here.
Policy & Regulatory Affairs
NCPA advocates for the FTC to enforce competition laws against PBMs for their anticompetitive activities: NCPA is working with top Federal Trade Commission officials to educate the FTC on the anticompetitive behavior of PBMs. NCPA also provided comments and a letter to the chair of the FTC, Lina Khan, regarding the most egregious practices, including patient steering, adhesion contracts, and discriminatory reimbursement practices.
NCPA meets with the White House Competition Council: NCPA’s former presidents, Michele Belcher, and Brian Caswell, each presented to the council and expressed concerns about the anticompetitive behavior of PBMs. NCPA encouraged the council to coordinate efforts between agencies to rein in PBMs and address the negative consequences associated with vertical consolidation in the health care sector.
NCPA government affairs assisted in the states: Our state government affairs team provided input to 34 states, including draft legislative language, bill review, letters of support/opposition and in-person testimony. The states we worked with this year were: Alabama, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
The following legislative measures were passed in the states in 2021:
Alabama SB 227: Prohibits a PBM from steering a patient to its affiliated pharmacies and from reimbursing its affiliated pharmacies at higher rates than non-affiliated pharmacies; requires a PBM to contract with a pharmacy that is willing to meet the terms and conditions for network participation.
Arizona SB 1356: Prohibits a PBM from holding a pharmacy responsible for a fee for any step, component, or mechanism related to the claims adjudication process.
Arkansas HB 1804: Makes changes to align existing law with the Rutledge v. PCMA decision; gives the Insurance Department enforcement authority over existing fair pharmacy audit laws.
Arkansas HB 1881: Prohibits a PBM from mandating that a patient uses a mail-order pharmacy or otherwise interfering with the patient’s right to choose an in-network pharmacy.
Arkansas HB 1852: Prohibits a pharmacy that is owned by an insurer/PBM or other similar entity from requiring a patient to receive prescriptions through home-delivery services.
Arkansas SB 617: Prohibits a pharmacy that is owned by an insurer/PBM or other similar entity from filling a prescription without express patient consent; requires the affiliated pharmacy to disclose the conflict of interest; prohibits an affiliated pharmacy from using patient data for solicitation purposes.
Colorado HB 21-1237: Directs the state to enter into a contract with a PBM for the administration of state employee health insurance through a reverse-auction process, and then use that platform to audit claims.
Maine LD 1450: Prohibits a PBM from using untrue, deceptive, or misleading advertising.
Maine LD 686: Requires PBMs and other drug supply chain entities to disclose certain drug pricing information to the state.
Maryland HB 601: Removes provisions exempting ERISA plans from regulations addressing the provision of pharmacy benefits.
Montana SB 395: Requires PBMs to become licensed with the state; prohibits a PBM from using untrue, deceptive, or misleading advertising; requires a PBM to offer adequate pharmacy provider networks.
New Hampshire SB 97: Protects a pharmacy’s authority to offer home delivery services from PBM interference.
New Mexico SB 124: Requires a health plan to reimburse a pharmacy within 14 days of receiving the claim.
North Dakota HB 1492: Prohibits a PBM from holding a pharmacy responsible for a fee for any step, component, or mechanism related to the claims adjudication processing network.
Oklahoma HB 2123: Establishes the Pharmacy Choice Commission to assist with the enforcement of PBM regulations.
Oklahoma HB 2677: Strengthens existing fair pharmacy audit protections and MAC list appeal procedures; permits a pharmacy to refuse to dispense a prescription if the reimbursement would be lower than the pharmacy’s cost of acquiring the drug.
Rhode Island SB 479: Prohibits a PBM from implementing gag clauses that prevent pharmacists from discussing a patient’s cost-share or lower-cost alternatives.
Tennessee HB 1398: Prohibits a PBM from interfering with a patient’s right to choose an in-network pharmacy provider through steering, coercive copays, or other means; requires PBM reimbursement rates to reflect a pharmacy’s actual acquisition costs.
Texas HB 1763: Prohibits a PBM from retroactively reducing claim amounts through effective rates, quality assurance programs, or other means; prohibits a PBM from reimbursing its affiliated pharmacies at higher rates than non-affiliated pharmacies; protects a pharmacy’s right to offer home-delivery services; prohibits a PBM from requiring accreditation requirements that are more stringent that those required by the state or federal government; protects a pharmacy from PBM retaliation for exercising its rights under the bill.
Utah SB 177: Strengthens existing fair pharmacy audit laws.
Virginia HB 2219: Makes existing patient choice and “any willing pharmacy” provisions applicable to PBMs, instead of just insurers.
West Virginia HB 2263: Requires a PBM to reimburse a claim in an amount that is not less than the drug’s NADAC plus a professional dispensing fee of $10.49; prohibits PBMs from charging a pharmacy a retroactive fee or from deriving revenue from a pharmacy or an insured; prohibits a PBM from reimbursing non-affiliated pharmacies at lower rates than it reimburses its affiliated pharmacies; prohibits a PBM from interfering with a patient’s right to choose an in-network pharmacy and from denying a pharmacy the opportunity to become an in-network provider, if the pharmacy is willing to agree to the network’s terms and conditions; removes a provision exempting PBMs serving ERISA plans from existing regulations.
Wisconsin SB 3: Requires PBMs to become licensed with the state; prohibits a PBM from implementing a gag clause; requires a PBM to provide notice of accreditation requirements for network participation; establishes fair pharmacy audit procedures.
Texas HB 1919: Prohibits a PBM/insurer or its affiliate from transferring patient data for a commercial purpose; prohibits a PBM/insurer from steering patients to, or requiring a patient to use, an affiliated pharmacy.
STATE PROVIDER STATUS
Arkansas HB 1134: Allows pharmacists to prescribe, administer, deliver, distribute, or dispense vaccines and medications to treat adverse reactions to administered vaccines to individuals 3 years old and up.
California AB 133: Requires the Department of Health Care Services to implement a medication therapy management benefit and reimbursement methodology for covered pharmacist services related to the dispensing of qualified specialty drugs.
California AB 1064: Authorizes pharmacists to initiate and administer immunizations to include any vaccine approved or authorized by the FDA for persons 3 years of age and older
Colorado HB 21-1275: Modifies Colorado’s Medicaid program to include payments to pharmacists when working in a collaborative practice agreement with a physician and allows clinical pharmacists services to be reimbursed at federally qualified health centers.
Florida SB 768: Authorizes certified pharmacists to administer vaccines to adults and to administer influenza vaccines to children 7 years of age or older.
Illinois SB 2017: Allows pharmacists to administer all vaccines recommended on CDC schedules and travel vaccines for those 7 and older; requires reimbursement at the physician rate.
Iowa SB 296: Allows pharmacists to engage in collaborative pharmacy practice and makes them eligible to receive payment or reimbursement under a health benefits plan.
Kentucky HB 48: Requires insurers to reimburse a pharmacist for a service or procedure at a rate no less than that provided to other nonphysician practitioners.
New York SB 4807: Authorizes pharmacists to provide specific vaccinations such as measles, mumps, and the COVID-19 vaccine for individuals over the age of 18
Maryland SB 736: Authorizes pharmacists to administer FDA approved vaccines to individuals 3-17 years old from July 1, 2021, until June 30, 2022.
Ohio HB 6: Authorizes pharmacists to administer any vaccine to individuals 13 and older and both influenza and COVID-19 vaccines to individuals 7-13 years old without a prescription.
Oklahoma SB 392: Requires an insurer to compensate pharmacists for services provided to enrollees.
Oklahoma SB 398: Authorizes pharmacists to administer any FDA approved or authorized vaccine without a prescription.
Oregon HB 2958: Requires insurance plans with prescription drug benefits to cover the cost of drugs prescribed and dispensed for preexposure and post-exposure prophylactic antiretroviral therapies.
Virginia HB 2333 and SB 1445: Per established process by the department of health, eligible health care providers can volunteer to administer the COVID-19 vaccine to residents of the commonwealth during a state of emergency related to the COVID-19 pandemic. Allows pharmacies to volunteer their facilities as COVID-19 vaccination sites.
Wisconsin AB 4: Allows certified pharmacy technicians to administer vaccines and pharmacy students to administer vaccines under the supervision of a pharmacist or provider who is already authorized.
Wisconsin SB255: Requires the state Department of Health Services to provide reimbursement under the Medicaid program to services provided by a licensed pharmacist.
STATE STUDIES/FINDINGS REGARDING PBM PRACTICES
NCPA helps Pa. county controller find money Wasted on PBMs: Over the past year, NCPA has provided information to Lehigh County Controller Mark Pinsley pertaining to his audit of the county employees’ prescription drug benefit. In his final audit, he determined proper oversight of its PBM, Express Scripts, could lead to potential savings of $1.4 million for the county. In discussions with NCPA, Controller Pinsley also expressed concerns that ESI was steering patients to out-of-state pharmacies, thus sending money out of the county and away from local, independent pharmacies.
Arkansas investigates PBM use of state funds: Pursuant to a request for information into the regulation of PBMs and state funds going to PBMs, the Arkansas Department of Insurance issued a report finding that PBMs are not in full compliance with state law, and that PBM drug formulary practices can create conflicts of interest.
Delaware investigates PBM administering state employee benefits: The Delaware State Auditor issued a report finding that the State Benefits Office cost taxpayers millions after paying its PBM $24.5 million more than it should have paid for state employees’ prescription drugs.
North Dakota shows savings by carving certain Medicaid beneficiaries out of Medicaid managed care: In testimony on the state’s Medical Services budget, North Dakota Medical Services staff released their findings that carving pharmacy benefits out of the managed care program for Medicaid expansion and the Children’s Health Insurance Program saved the state $17.259 million, exceeding the projected savings of $6.091 million.
State government affairs
PBM Reform Does not Raise Costs
A new NCPA resource confirms that controlling PBM conflicts of interest does not raise costs for patients or payers. The one-pager compares changes in health insurance premiums in states that enacted PBM reform to the average changes in health insurance premiums nationwide.
NCPA presented to the National Association of Insurance Commissioners’ (NAIC) PBM Regulatory Issues Subgroup on obstacles to robust enforcement of state PBM laws. Additionally, in a letter to NAIC, NCPA and 41 state pharmacy associations called on the organization to create accurate education material regarding the U.S. Supreme Court Rutledge decision.
FL: State Re-evaluating State PBM Contracts
Florida Gov. Ron DeSantis (R) announced plans to sign an executive order that would hold PBMs accountable and provide drug cost transparency. Community pharmacy advocates, including NCPA, provided comments pointing out that PBMs’ inherent conflicts of interest.
PBM Enforcement Regulatory Comments
This summer, the New York State Department of Financial Services’ Pharmacy Benefits Bureau released multiple requests for information on how to best implement rules relating to the regulation of PBMs, as well as the application of existing laws to PBMs operating in New York. This bureau is a newly created entity in New York tasked with oversight and regulation of PBMs. Because state actions AFTER the passage of legislation are vitally important, NCPA responded to several of the requests.
- NCPA provided comments on the duty, accountability, and transparency of pharmacy benefit managers to health plans under NY Public Health Law Section 280-a(2).
- NCPA provided guidance on the application of state insurance laws to PBMs administering benefits to Medicare Part D plans.
- NCPA provided recommendations to New York State’s Pharmacy Benefits Bureau addressing the anticompetitive practice of patient-steering.
NCPA submitted a response to the New York Department of Financial Services’ request for information regarding PBM transparency highlighting the importance of rules requiring PBMs to disclose certain benefit information to their plan sponsor clients.
PBM Reform Legislation
WV: Governor to Sign Patient Choice Bill into Law
NCPA submitted a letter urging West Virginia Gov. Jim Justice (R) to sign HB 4112 into law. The bill would give patients greater authority to choose which in-network pharmacy to fill their prescriptions and would address the arbitrary “specialty” designation that PBMs use to steer patients to PBM-owned pharmacies. The bill is awaiting action by the Governor.
NE: Governor Signs PBM Licensure Bill into Law
Nebraska Gov. Pete Ricketts (R) signed LB 767 into law. The law requires PBMs to obtain a license to operate in the state and provides the state with regulatory oversight over PBMs. NCPA submitted a letter of support for the bill.
KY: House Passes PBM Reform Legislation
HB 457 passed the House and is in the Senate. This bill provides comprehensive PBM reforms to protect patient choice and pharmacy access in Kentucky. NCPA is proud to support this legislation.
IA: PBM Reform Bill Passes the House
Iowa HF 2348 has passed the House. The PBM reform bill contains protections from intrusions on patient choice, network participation, retroactive claim adjustments, opaque reimbursement methodologies, and other PBM abuses. The bill is now being considered by the Senate.
KS: House Passes Pair of Pro-Pharmacy, Pro-Patient Bills
The Kansas House passed House Substitute for SB 28, that requires PBMs to be licensed rather than registered in the state, thus giving more regulatory oversight of PBMs to the Kansas Department of Insurance. It increases both the fee and penalties for PBMs, as well as creates a MAC appeals process. The House also passed SB 200 which authorizes a pharmacist to initiate therapy within the framework of a statewide protocol for the flu, strep, or urinary tract infections. The Senate must now consider amendments to each bill made by the House.
MO: PBM Reform Bill Passes the House
Missouri HB 1677 has passed the House. The PBM reform bill addresses patient choice, PBM-affiliated pharmacy reimbursements, under-water reimbursements, and other PBM abuses. The bill is now being considered by the Senate.
OK: Patient Choice Bill Passes Senate
Oklahoma SB 1860 passed the Senate. The patient choice bill strengthens existing patient protections by protecting a patient’s ability to choose the in-network provider of his or her choice. The bill is now being considered by the House.
VA: Patient Steering Bill
NCPA submitted a letter in support of HB 560, which would prohibit a PBM from engaging in patient steering. The committee voted to continue the bill to 2023.
WA: Washington Patient Choice Bill
NCPA submitted a letter of support for HB 1813, which would protect a patient’s authority to utilize the pharmacy provider of their choice. The bill ultimately died in the Senate.
SD: PBM Reform
NCPA supported South Dakota SB 163. Ultimately, the bill failed sine die. NCPA’s written testimony can be found here.
HI: Senate Passes PBM Legislation
The Hawaii Senate passed SB 2443, which gives the Insurance Commissioner greater authority to enforce new and existing provisions protecting patients and pharmacies from PBM abuses. NCPA submitted a letter of support for its companion bill, HB 1783.
VT: House Passes PBM Bill
The Vermont House has passed HB 353. The PBM reform bill protects patient choice, strengthens existing MAC appeals language, adds pharmacy audit protections, and addresses PBM conflicts of interest. The bill is now in the Senate.
MI: Gov. Signs PBM Bill into Law
Gov. Gretchen Whitmer (D) signed HB 4348 into law. Among other things, it:
- Requires a PBM to be licensed in the state;
- Eliminates transaction fees and clawbacks;
- Eliminates spread pricing;
- Prohibits discriminatory treatment of non-affiliate pharmacies by PBMs; and
- Requires pharmacy audit protections
TN: Governor Signs PBM Bill supported by NCPA
Gov. Bill Lee (R) signed HB 2661 into law. The act requires PBMs to adopt reimbursement methods that accurately reflect actual acquisition costs and protect patients from being forced to use PBM-owned pharmacies. NCPA joined the Tennessee Pharmacists Association and other pharmacy advocacy groups on a letter to Gov. Lee urging him to sign the bill into law.
VT: PBM Bill Signed into Law
Vermont Gov. Phil Scott (R) signed H. 353, a bill that addresses patient steering and also requires the state to look into issues such as reimbursement transparency, spread pricing, and other PBM practices that raise costs for patients and plans. While the bill was in the legislature, NCPA submitted a letter urging lawmakers to pass the bill.
WV: Governor Signs Patient Choice Bill into Law
West Virginia Gov. Jim Justice (R) signed HB 4112 into law. The bill gives patients greater authority to choose which in-network pharmacy to fill their prescriptions and would address the arbitrary “specialty” designation that PBMs use to steer patients to PBM-owned pharmacies. NCPA sent a letter of support to Gov. Justice.
OK: PBM Bill Signed into Law
Oklahoma Gov. Kevin Stitt (R) signed SB 737 into law. The legislation protects patients and pharmacies from PBM abuses by giving the insurance commissioner greater enforcement authority over PBMs, prohibiting the practice of spread pricing, and prohibiting pharmacy network participation fees.
FL: PBM Bill Signed into Law
Florida Gov. Ron DeSantis (R) signed HB 357 which allows pharmacies to file an appeal with the Agency of Health Care Administration if a pharmacy disagrees with the final report of a PBM audit and the Agency will help resolve the dispute. Additionally, the act gives the Agency greater enforcement authority to go after PBMs that are not complying with state law.
KS: PBM Licensure Bill Signed into Law
Kansas Governor Laura Kelly (D) signed SB 28 into law. The bill requires PBMs to become licensed with the state and increases the insurance commissioner’s enforcement authority over PBMs.
FL: State re-evaluates PBM contracts
The Florida Agency of Health Care Administration, which oversees the state’s Medicaid program, invited NCPA to discuss proposals to improve the Medicaid managed care program. The invitation was a follow-up to comments NCPA had submitted in response to the Agency’s “request for information” on ways to protect patient access to community-pharmacy services in the Medicaid managed care program.
WA: Centene Settlement
The Washington State Attorney General announced that Centene would pay the state a whopping $33.3 million for overcharging Medicaid. Attorney General Bob Ferguson called this Medicaid fraud recovery “the second-largest in state history.”
NY: Gov. to Support Medicaid Pharmacy Reimbursement Reform
In a letter to Governor Hochul (D), NCPA asked that she honor her commitment to address Medicaid Managed Care (MMC) pharmacy reimbursement reform in the budget process. Governor Hochul’s reasoning was that Medicaid pharmacy reimbursement reform should be addressed in the budget process. Unfortunately, she did not include this important language in the executive budget.
Scope of Practice Expansion/Compensation for Services/ Legislation
MA: NCPA Supports Point of Care Testing in Massachusetts
NCPA submitted a letter of support for S 2567, that establishes a statewide protocol for pharmacists to test or screen and initiate treatment for qualified health conditions. The bill allows pharmacies to obtain Clinical Laboratory Improvement Amendment (CLIA) waivers to expand on the types to health screening tests including but not limited to influenza, COVID-19, and HIV. HIV would include PEP and PrEP therapies.
MD: Long Acting Injectables
NCPA submitted written testimony and spoke in front of the Maryland House of Delegates’ Health & Government Operations Committee for HB229. This bill expands the definition of “maintenance injectable medication” to include sexually transmitted infections and to allow those medications to be administered by a pharmacist.
NE: Pharmacy Technicians
NCPA, the National Association of State Pharmacy Associations (NASPA) and the American Pharmacists Association (APhA) sent a joint letter to support LB812, which would authorize pharmacy technicians to administer vaccines under a pharmacist’s supervision.
MD: HIV PrEP/PEP Authorization for Pharmacists
NCPA submitted written testimony and spoke through teleconference to the Maryland Senate Environmental, Health and Education Committee in favor of Senate Bill 355 which would authorize pharmacists to prescribe and dispense up to a 30-day supply of “preexposure prophylaxis” (PrEP) or a complete course of “postexposure prophylaxis” (PEP) to patients outside of a therapy management contract. The bill has passed the Senate is being considered by the House.
RI: Tobacco Cessation and Contraception Prescribing Authority
NCPA, APhA and NASPA signed a joint letters to support S 2329 and S 2330 as testimony presented to the Rhode Island Senate Committee on Health and Human Services. S 2329 authorizes pharmacists to prescribe and dispense tobacco cessation medications and S 2330 permits pharmacists to prescribe and administer all FDA-approved hormonal contraceptives. Both pieces of legislation include mandatory coverage from state Medicaid programs and commercial insurers.
IL: HIV PrEP/PEP Administration
NCPA submitted written testimony in support of HB 4430, which allows pharmacists to administer “preexposure prophylaxis” (PrEP) and “postexposure prophylaxis” (PEP) to treat human immunodeficiency virus (HIV). This legislation includes mandatory coverage and compels payers to reimburse pharmacists no less than 85% the rate of other providers who provide the same service.
MO: Pharmacists’ Vaccine Authority
NCPA and NASPA submitted written testimony to the Missouri House of Representatives in support of House Bill 2452 which allows pharmacists to administer FDA-approved and ACIP recommended vaccines to individuals 7 years and older.
MD: Provider & Reimbursement Status
NCPA joined with NASPA and APhA to provided written testimony to the Maryland House Health & Government Operations Committee in support of House Bill 1219 which recognizes pharmacists as health care providers and authorizing reimbursement parity for their services.
VA: Workplace and Patient Safety
NCPA submitted a letter of support to the Virginia Senate Committee on Education and Health in support of House Bill 1323 which directs the state Board of Pharmacy to adopt regulations related to workplace safety that protects the health and safety of patients.
MN: HIV PrEP/PEP Pharmacists’ Authority
NCPA submitted written testimony to the Minnesota House Health Policy and Finance Committee in support of HF 3854 which would authorize pharmacists to prescribe and dispense “preexposure prophylaxis” (PrEP) and “postexposure prophylaxis” (PEP) to treat human immunodeficiency virus (HIV).
NCPA celebrates with Pennsylvania Pharmacists on expansion of independent immunization authority: House Bill 2676 passed both chambers within the Pennsylvania State Legislature and has been signed by the Governor, authorizing pharmacists to independently administer COVID-19 and influenza to individuals five years of age and older.
MD: Scope of practice
Maryland General Assembly passed two bills: House Bill 229 and Senate Bill 62. HB 229 that authorizes pharmacists to administer injectable medications that treat sexually transmitted infections and mandates and SB 62 expands pharmacist scope of practice by including the prescribing and dispensing of “nicotine replacement therapy medication” to aid in tobacco or smoking cessation.
AK: Gov. Signs Provider Status Bill
Governor Mike Dunleavy (R) signed House Bill 145, which clarifies immunization authority for pharmacists and other services outside of a collaborative practice agreement and provides payment, NCPA submitted a letter of support for this legislation.
LA: Enhanced reimbursement
NCPA submitted a letter of support for SB82 to the Louisiana Senate Committee on Health and Welfare to advocate for enhanced reimbursement for pharmacy services. Unfortunately, the bill did not make it through the process.
OK: Gov. signs Pharmacists Provider Status
NCPA celebrated with the Oklahoma Pharmacists Association as the Governor signs into law, HB 2322, recognizes pharmacists as providers and mandates payment parity for healthcare services through the state Medicaid program.
VA: Pharmacy work requirements
HB 1324, which directs the state Board of Pharmacy to adopt regulations related to workplace safety, became law after approval from the both the Virginia House and Senate and the Governor taking no action. NCPA has emphasized the importance of work requirements within pharmacies to protect both patients and staff.
NY: Antitrust Bill
NCPA joined eleven other small business organizations on a letter supporting New York’s 21st Century Antitrust Act. The bill would give the state greater authority to oversee large corporations, such as PBMs, that stifle competition from smaller businesses.
The Maryland Insurance Administration (MIA) released a report concluding that, if the state were to apply its PBM laws to PBMs serving ERISA plans, enforcement of those laws would not be preempted by the federal ERISA law.
MD: PSAO Regulation Reforms
NCPA submitted comments on Maryland HB 973, which would address issues in existing regulations of pharmacy services administrative organizations (PSAOs). The bill was passed by the House and is being considered by the Senate.
NCPA’s Month of Action a Success: During NCPA’s Month of Action, more than 60 visits with legislators, or administration officials, occurred or were planned, including 22 visits with legislators on key committees or leadership. These include Senate Finance Chairman Ron Wyden visiting a pharmacy along with CMS Administrator Chiquita Brooks-LaSure. This was also attended by former NCPA President Michele Belcher.
Calls to action (CTA) were sent to members:
Alert sent to members urging them to contact their legislators about signing onto a joint Congressional letter to TRICARE about the recent changes to the pharmacy network by ESI. Over 1,800 emails were sent in the first 24 hours the alert was live. The alert also contained links to resources pharmacies can use in their pharmacy to engage their patients.
Alert sent targeting Senators urging cosponsorship of S. 4293 The Pharmacy Benefit Manager Transparency Act of 2022 resulting in 3,169 comments to Senate offices
Alert sent to Indiana Pharmacies urging support for a bill that would grant pharmacies prescriptive authority in certain instances
The Innovation Center develops and executes programs that inform and educate community pharmacists, allowing them to realize opportunities in an evolving health care market. In addition, NCPA Innovation Center demonstrates, researches, and supports new and expanded roles for community pharmacists.
Below are some highlights of 2022.
The NCPA Innovation Center/CPESN® Community Pharmacy Fellowship welcomed its inaugural class of graduates. The fellowship is a one-year, post-graduate program open to any pharmacist practicing in an independent pharmacy across the country. The group meets throughout the year for topic discussions on clinical reviews, workflow practices, and enhanced services implementation led by independent pharmacy leaders. The second cohort is underway and scheduled to graduate in 2022. For more information and applications, visit ncpa.org/fellowship.
Community Pharmacy Residency and Fellowship Showcase
NCPA’s Residency Showcase featured community-based pharmacy residency and state association fellowship programs from all across the country. Students flooded the showcase for its entirety- so much that several also attended NCPA’s virtual community pharmacy residency and fellowship programming.
Immunizations with Auburn University
We are in the last year of a 5-year CDC grant with Auburn University: Enhancing Implementation of Immunization Practice Standards Among Independently Owned Community Pharmacies to increase pharmacy adherence to immunization practice standards and readiness. The program has delivered education and resources to community pharmacy personnel to facilitate implementation and enhancement of immunization services and has fostered collaboration with other stakeholders to facilitate adoption and reduce barriers.
Sexually transmitted infection patient care
Working with the National Association of County and City Health Officials to support pharmacies and local health departments to offer expanded sexually transmitted infection patient care in pharmacy settings. Thirteen pharmacies were selected to work with four local health departments in 2023.
Advanced Pharmacy Leadership Training
Training new pharmacy leaders is an important focus for NCPA and the NCPA Innovation Center. In 2020, we launched a revolutionary training program that broke down the top 16 profit building strategies for community pharmacy and gave participants a backstage tour of our most successful members pharmacies and the resources they use. Now in our third class of leaders, the NCPA Innovation Center/CPESN® Community Pharmacy Fellowship has demonstrated it’s ability to jump start profits through clinical services over this one-year program open to any pharmacist practicing in a community pharmacy. For more information on enrollment, visit ncpa.org/fellowship.
Diabetes Prevention Program
2022 closed out the final cohort of the NCPA Innovation Center’s contract with the CDC. This was a 4-year endeavor to provide diabetes prevention programs in independent pharmacies. NCPA collaborated with ADCES and OmniSYS to provide the participating 48 pharmacies with technical support as they worked toward preliminary recognition.
Pathways to Pharmacy Ownership
NCPA collaborates with the Minority Pharmacist Entrepreneur Conference (MPECRx) to offer Pathways to Pharmacy Ownership, an application-based initiative that provides education, resources, and mentorship to minority pharmacists interested in opening or purchasing a pharmacy.
In 2022, the inaugural year of this program, ten pharmacists were selected to participate in monthly virtual webinars and mentor discussions to learn about topics like personal finance, business planning, pharmacy benchmarking, pharmacy acquisitions, accounting, leadership, and more.
Pharmacists were offered scholarships to attend the October 2022 Pharmacy Ownership Workshop, Sponsored by McKesson in Kansas City, MO at the NCPA Annual Convention. In 2023, up to twenty pharmacists will be invited to participate in the Pathways program.
CPESN USA has implemented over 220 value-based contracts with payers, partners, and purchasers, with over 125 of those – representing an opportunity of $17.9M –underway in 2023. There are 3,500 CPESN pharmacies in 48 states covering over 83% of the U.S. population and providing over 28M hand-deliveries to patient’s doorsteps every year. CPESN pharmacies administered over 6.5M COVID-19 doses through their involvement with the Federal Retail Partner Program and the CDC.
Growth and Profitability Programs
Pharmacy-Based-Point-of-Care Testing Certificate Program
NCPA collaborates with NASPA to present the Pharmacy-Based Point-of-Care Test & Treat National Certificate Program. In 2022, the program was presented five times: twice virtually, and three times in-person. 261 pharmacy team members participated in the program and brought point-of-care testing back to their pharmacies. To learn more about the program and check on dates for 2023, click here.
The Business of Long-Term Care Workshop
The Business of Long-Term Care Workshop was offered in-person twice in 2022. Paul Shelton and his team at PharmaComplete Consulting Services walked participants through the basics of LTC, contracting, marketing strategies, pharmacy operations, technology innovations and efficiencies, and more in this two day-long workshop. Learn more about the Business of Long-Term Care and get dates for 2023 here.
Creating Health: a Pharmacist-Led Lifestyle and Weight Management Program, taught by Dr. Kathy Campbell, owner of Medicap Pharmacy® in Owasso, Oklahoma, provides a healthy foundation for providing lifestyle and weight management services as pharmacist. The program was back for an in-person meeting at Annual Convention 2022 and Cardinal’s RBC 2022 with great feedback from participants, and it’s available on-demand here.
Thinking Outside the Vial
Thinking Outside the Vial is a functional medicine series giving pharmacists deeper insight into topic areas such as pain and inflammation, gastrointestinal diseases, cardiovascular health, hormones, and allergic diseases. In March of 2021, a limited-time-only session was added on COVID-19 immune support with vitamins and supplements. For information, go here.
Enhanced Services Boot Camp
Enhanced Services Boot Camp at offered at Connect 2022. Attendees learned from independent pharmacy leaders Joe Moose, Michelle Belcher, and Tripp Logan on how to best implement enhanced services in their pharmacy. Sessions cover workflow, point-of-care testing, staff engagement and utilization, and working with public health.
Pharmacy Ownership Workshop
Pharmacy Ownership Workshop was presented both in-person and virtually in four events during 2022.
More than 3000 pharmacists have attended the Ownership Workshop and more than 50 percent of past workshop participants now own their own pharmacy.
Diabetes Accreditation Boot Camp
The NCPA Innovation Center partnered with Travis Wolff from PharmFuther to offer the Diabetes Accreditation Boot Camp three times in 2022. Offerd in a virtual format, this online course helps prepare 85 pharmacy teams for DSME accreditation in 2022. For more information, click here.
The NCPA Innovation Center produced 146 CE sessions in 2022 for the NCPA Learning Center, NCPA Annual Convention, Cardinal’s RBC, and AmerisourceBergen’s ThoughtSpot. Pharmacists and pharmacy technicians enrolled in education programs produced by the NCPA Innovation Center in 2022 through webinars, CE articles, or live sessions. A few of the most popular live webinars and on-demand sessions were: Implementing a social determinants of health program in community pharmacy; Don’t Say we Didn’t Warn You: Preparing for the DIR Hangover, DSCSA, and other Regulatory Items that should be on your 2023 Pharmacy Checklist; Billing for Diabetes Education Just Got Easier; and Building a Business with Long-Term Care in 60 Minutes or Less. At the NCPA Annual Convention 2022, all session rooms were packed, but a particular standout was 7 Fool-Proof Ideas for Incentivizing and Motivating Your Team and Maximizing Efficiencies with Adherence Operations. Feedback for next year’s programming called for staff engagement, enhanced services, and business development. Visit https://ncpa.org/learn to view current CE offerings.