NCPA continues push for any willing pharmacy provision for Medicare Part D plans

The National Community Pharmacists Association (NCPA) continues to advocate for legislation that would allow community pharmacies to participate in all Medicare Part D drug plan networks, including “preferred” networks.

The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577), introduced in May by U.S. Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.), is a top priority for NCPA members with its “any willing pharmacy” provision in Medicare Part D, which would allow pharmacies located in medically underserved areas of the United States to serve all Medicare patients, even those with a health plan involving a “preferred network,” said NCPA CEO B. Douglas Hoey, RPh, MBA, during a media call at the 2014 NCPA annual meeting in Austin, Texas.

H.R. 4577 has gained bipartisan support with 73 co-sponsors from 32 states so far, including House Judiciary Committee Chair Bob Goodlatte (R-Va.); House Transportation & Infrastructure Chair Bill Shuster (R-Pa.); and House Rules Committee Ranking Member Louise Slaughter (D-N.Y.).

“Our members, who we surveyed in late 2013, told us their #1 issue was exclusion from Part D preferred networks. So we ramped up our focus to enable pharmacies to participate…at the same terms and conditions as others,” said Hoey. “We have seen some demonstrable progress in allowing independent community pharmacies and regional chains to be able to participate in Part D preferred networks in 2015.”

Steve Pfister, NCPA’s senior vice president of government affairs, noted that NCPA members continue to reach out to their U.S. representatives for support of H.R. 4577. So far, a Senate companion bill has not been introduced.

“With 14 days before a very pivotal election that will determine the balance of power in the [U.S.] Senate, we don’t know if there will be action in the Senate on this legislation in the balance of this year, but it will be a priority moving into the 114^th Congress in January,” Pfister said on the call.

Generic price spikes

Because of the change in the marketplace, the prices of some generic products have increased 1,000% or more from the previous year, according to Pfister, making it difficult for independent pharmacies to stay in business.

NCPA has pushed for congressional oversight hearings on the generic price spikes.  Sen. Bernie Sanders (I-Vt.) and U.S. Rep. Elijah E. Cummings (D-Maryland) recently launched an investigation into the price increases for generic drugs. They sent a letter to 14 CEOs of pharmaceutical companies requesting information about the escalating prices with a deadline of October 23. They also sent a letter to Health and Human Services Secretary Sylvia M. Burwell, asking the Obama administration to examine the generic price hikes.

“We will continue to monitor this closely and are very hopeful during the lameduck session of Congress that there will be an oversight hearing conducted on this issue, which has been very problematic for community pharmacy,” Pfister said.

PBM transparency

In addition to generic price increases, community pharmacies have had to deal with reimbursements for generic prescriptions below their costs as some pharmacy benefit managers have not updated their maximum allowable cost (MAC) lists for several weeks.

“We are pleased that the final CMS rule [for 2015 Part D prescription drug benefit programs] did include provisions regarding transparency on MAC pricing for generics, and payment updates every seven days. That was a significant provision,” he said.

In addition, H.R. 4437, The Generic Drug Pricing Transparency Act, has been introduced and is another NCPA priority. The legislation would allow a pharmacy to know how its individual MAC rates will be determined and would require reimbursements to keep pace with actual market costs, according to NCPA. So far, the legislation has been supported by 13 co-sponsors.