Engage With State, National Pharmacy Associations to Work on Policy Change

Although there have been several significant legislative successes recently, there is still work to do to change public policy for independent pharmacies, according to a session at McKesson ideaShare 2022.

Different areas of the industry are coming together to work on policy change, both at the federal and state levels, according to Nimesh Jhaveri, president of community pharmacy and health at McKesson. To illustrate the ways in which different organizations are coming together, Jhaveri spoke with leaders from the National Community Pharmacy Association (NCPA) and the American Pharmacists Association (APhA) during the session.

“If we can’t come together with one voice, there’s no way we can continue to further our profession,” Jhaveri said.

Pete Slone, senior vice president of government affairs at McKesson, agreed that this collaboration is essential. Despite the frustrating level of partisanship seen in Washington DC, Slone said there are many people working together to advocate and support the profession.

The next few months have a particularly packed legislative calendar, with the midterm elections approaching and leaving only about 6 real work weeks left for federal legislators. Therefore, the traditional legislative process is largely on hold, and Slone said it is more likely that smaller, individual legislation will find its way onto larger bills, rather than being passed individually. Pressing social issues such as the recent Supreme Court decision on abortion, the conflict in Ukraine, and the economy are also taking up much of legislators’ attention.

“The focus of policymaking has become much more dispersed, and our collective advocacy needs to be directed into new forms and different forums than we’ve been accustomed to,” Slone said.

One of the ongoing areas of focus for pharmacy advocates is pharmacy benefit manager (PBM) reform, including reform to direct and indirect remuneration (DIR) fees. Slone said there is new legislation to address spread pricing and arbitrary claw-backs, and passing the Equitable Community Access to Pharmacist Services Act is a major focus. This bill would direct reimbursement for certain services under Medicare and introduces a payment mechanism for future emergencies.

To strengthen the collective voice of pharmacy advocates, Slone said McKesson has partnered with other organizations, including APhA, to create the Future of Pharmacy Coalition, which is focused on advocating for provider status. The coalition has attracted support from patient advocacy groups as well as other organizations and professions, and Slone said this united voice is a major opportunity to get legislation passed.

“Pharmacy has never undertaken such a bold campaign to forge a community of allies galvanized by a shared vision,” Slone said. “We’ve never been more united and appreciated, but let’s work together to translate that into some wins that are truly within our reach.”

Following Slone’s presentation, Jhaveri invited NCPA CEO Doug Hoey, RPh, MBA, and Ilisa Bernstein, interim executive vice president and CEO of APhA, to the stage to discuss the importance of collaboration.

When considering DIR reform and the final rule that was recently released by the Centers for Medicare and Medicaid Services, Hoey said the best way to evaluate it is by seeing the response from PBMs. American Health Insurance Plans strongly opposes the rule because they say it only benefits pharmacists.

Hoey said the rule provides predictability and transparency at the point of sale, but there is still more to be done on this issue. A major step ahead is changing the overall pharmacy payment model, and Hoey said he believes Medicare Part D needs some changes. He said this is a challenging issue for legislators to tackle, but there are conversations happening among legislators about this potential step.

In one of the most recent developments, the FDA expanded the emergency use authorization for Paxlovid, a COVID-19 antiviral, allowing pharmacists to prescribe it to patients. Bernstein said this is a case study in advocacy, as many people have been working behind the scenes to educate legislators about why this is necessary and why pharmacists are essential to expanding access to COVID-19 antivirals.

Importantly, however, there are still obstacles in the way of many pharmacies who wish to prescribe Paxlovid. The amendment requires patients to present their medical records to the pharmacist to evaluate before prescribing, which Bernstein said is a win, but this takes 20 to 30 minutes that pharmacists may not have. Furthermore, payment for this service is still far below what pharmacists deserve, and Bernstein said advocates are continuing to reach out and push for payment.

“Now the advocacy is turning toward…getting all of us paid appropriately and fairly for that,” Bernstein said.

Finally, the panelists discussed what collaboration across the pharmacy industry looks like and why it can be so powerful. Slone pointed out that legislators often say that they will only act once there is a united voice from the pharmacy industry, and the Future of Pharmacy Coalition is an effort to provide that. There are many opportunities for pharmacists to be involved with patients more directly, whether through point-of-care testing or working with polypharmacy conditions, but payment is essential for that to move forward.

All of the panelists urged pharmacists to get involved and contact their legislators. Bernstein emphasized that taking advantage of the current momentum is crucial.

“We have to seize this opportunity,” she said. “We have to demonstrate that we can do this and that we can prescribe.”

REFERENCE

Jhaveri N, Slone P, Hoey D, Bernstein I. Public Policy Session. McKesson ideaShare 2022. July 9, 2022.