Dear Colleague,
I'm on my way to Kansas City for NCPA's Annual Meeting, so I'll be brief this week: You have a once in a generation opportunity to have a voice in fixing the broken Medicare Part D program that is responsible for putting pharmacies out of business.
For years, NCPA has argued that many Medicare Part D pharmacy contracts contain terms that are neither reasonable nor relevant. Congress agreed and earlier this year directed CMS to define and enforce standards for Part D pharmacy contracting.
Now CMS is asking for input.
The agency recently issued a Request for Information seeking comment on pharmacy reimbursement, performance measures, audits, contract terms, dispensing fees, and other provisions that affect pharmacies' ability to care for Medicare beneficiaries. This is the first step toward future rulemaking, and it may be the most important opportunity we have had to build the case for meaningful reform.
NCPA intends to make the most of it, and I hope you will too.
In the coming days, we will provide members with a response template and guidance to help you prepare comments. But let me stress one point: CMS is not looking for form letters. CMS is also not looking for complaints about PBMs. If you are using our basic template, please add your specific facts, examples, and evidence.
That means stories about how badly PBMs reimburse your pharmacy — while true — won't be helpful.
Most likely, you've experienced below-cost reimbursement, opaque performance programs, retroactive fees, unreasonable audits, or contract provisions that make it harder to serve patients. CMS needs to hear from you about that anti-competitive behavior, but it must be backed by examples and data from your pharmacy. CMS' RFI shows they listened to NCPA's feedback on what is, and what is not, reasonable and relevant. Now they want the data to back it up.
The strongest comments will be those that combine personal experience with real-world evidence. That being said, please note that these are public comments. You should be mindful of your contractual obligations, and should not include any information that might be considered proprietary or confidential.
This is not just another comment period. It is an opportunity to shape the rules that govern Part D contracting for years to come.
In the coming days, NCPA will provide additional guidance to help you put your comments together. When it arrives, I encourage every independent community and LTC pharmacy to participate. The deadline for comments is Nov. 23.
CMS is asking the right questions. Let's make sure they hear the right answers.
I look forward to seeing you in Kansas City this week.
Best,
Douglas Hoey, Pharmacist, MBA
NCPA CEO
