Keep prescription drug benefits in ACA, NCPA urges

The NCPA is urging senators to keep a number of prescription drug-related provisions in any overhaul or replacement of the Affordable Care Act (ACA).

“Prescription drug coverage is an essential health benefit. Any meaningful drug coverage should include patient choice of pharmacy and access to face-to-face counseling with a community pharmacist they know and trust,” NCPA CEO B. Douglas Hoey wrote in a letter to Senate Majority Leader Mitch McConnell (R-KY). The letter also went to the 12-member working group of Republican senators who are developing legislation in response to House passage of H.R. 1628, the American Health Care Act.

Pharmacist-provided prescription drug therapy is “incredibly cost effective” in helping improve medication adherence by patients, according to Hoey. Plus, it “improves health outcomes and reduces much more expensive interventions, such as emergency room treatment.”

Up to $290 billion in annual health care expenses result from the lack of medication adherence, and a leading predictor of adherence is a patient’s proximity to and relationship with a pharmacist, Hoey wrote. “Patients must be able to choose a pharmacy that best meets their individual health needs,” Hoey added.

In the letter, NCPA also recommended:

• Support for patient access to medication and to ensure reasonable pharmacy reimbursement that includes both a community pharmacy’s medication acquisition and dispensing costs in any Medicaid reforms. “Bipartisan Senate efforts resulted in section 2503 of the ACA to recalculate Average Manufacturer Price (AMP) and its application to Medicaid pharmacy reimbursement. Subsequent regulations to implement this provision clarified that such reimbursement should include the cost of the medication as well as the cost of dispensing. Taken together, these policies helped ensure continued access to prescription drugs for Medicaid patients at community pharmacies.”

• Expansion of patient access to community pharmacists to help manage chronic conditions. Section 10328 of the ACA enhanced Medicare Part D medication therapy management programs, including an annual face-to-face comprehensive medication review, NCPA said. “This benefit should be retained and expanded to further integrate pharmacists into the health care delivery team.”

• Assurance of greater oversight of and transparency from PBMs in federal health-care programs. “Prescription drug affordability and accessibility are a top concern and they cannot be meaningfully addressed without a close examination of PBMs and how they contribute to rising drug costs.”

• Maintaining regulatory relief for small business community pharmacies, “with exemptions from onerous and redundant accreditation standards.”