Transparency and Pharmacy Access: Top Priorities for Independent Pharmacists

As the voice of independent pharmacists, the National Community Pharmacists Association (NCPA) works to align our advocacy efforts with the most pressing legislative priorities of our members. Independent pharmacists share their individual concerns with us throughout the year, but to quantify the advocacy priorities for the membership at large, we recently surveyed our members for the fourth consecutive year.

This year, the survey results were clear, but unfortunately not surprising. By a wide margin, independent pharmacists identified addressing direct and indirect remuneration (DIR) fees in Medicare Part D as their top priority. “DIR” fees are often imposed by pharmacy benefit managers (PBMs) weeks or even months after a prescription has been dispensed, making it difficult for pharmacies to determine their actual reimbursement rate at point of sale.

Moreover, the rationale for these fees is often undisclosed to the pharmacy. Bipartisan legislation introduced in both the US Senate and House of Representatives in 2016 sought to address this by requiring PBMs to calculate and disclose these fees at the point of sale, providing increased transparency. While this legislation was not voted on in the 114^th Congress, NCPA will work vigorously to have similar legislation introduced and enacted in the 115^th.

Another transparency issue ranked second in the survey results. Independent pharmacists want Congress to address below-cost reimbursements for many generic medications by requiring PBMs to disclose sources used to determine maximum allowable costs (MAC) for generic drug payments and ensure these are regularly updated to reflect market conditions. When the prices of generic medications skyrocket, PBMs move slowly to update the MAC price list causing pharmacies to suffer losses of as much as $100 or more on a single prescription. Thus far, 32 states have passed some form of MAC transparency legislation, and NCPA will continue to support federal legislative efforts to apply similar transparency principles to federal programs such as Medicare, TRICARE and the federal employee health benefit program.

Finally, independent pharmacists want the opportunity to compete for Medicare patients on a more level playing field. To that end, NCPA will continue to advocate for “any willing pharmacy” legislation that would allow any pharmacy willing to accept a Medicare drug plan’s contractual terms and conditions the ability to participate as a “preferred” pharmacy and offer patients the lowest cost sharing levels advertised by the plan. This is particularly critical for beneficiaries in traditionally underserved rural and urban communities that may lack access to the chain pharmacies that are often the sole “preferred” choice in many plans. Congressional support for “any willing pharmacy” has steadily increased, with legislation in the 114th Congress obtaining more than 100 bipartisan co-sponsors in the House of Representatives.

While these issues were identified as the most pressing areas requiring legislative action, NCPA is also prepared to defend bipartisan provisions in the Affordable Care Act (ACA) and Medicaid that increase transparency and pharmacy access.

With one party control of Congress and the White House, there is greater likelihood that a replacement to the Affordable Care Act could be enacted. NCPA will work vigorously to ensure that provisions of the law that required greater PBM transparency for Medicare and exchange plans as well as implementing regulations that recognized the importance of access to prescription medications in promoting patient health and reducing overall healthcare costs are preserved in any replacement package.

Additionally, there may be efforts to overhaul Medicaid. Independent pharmacies serve traditionally underserved populations and Medicaid prescriptions account for roughly 17% of the average independent pharmacy’s revenue. NCPA will work to protect Medicaid provisions that provide for fair reimbursements on generic medications under the program by accounting for both ingredient and dispensing costs. Such provisions allow pharmacies to continue to serve the Medicaid population and in turn ensure beneficiaries have adequate access to pharmacy services.

Independent community pharmacists serve on the front lines of our nation’s health care system and serve some of the most vulnerable patients in our communities. Enacting these common sense priorities would be a good start to ensure patients continue to have meaningful access to health care professionals they trust.

B. Douglas Hoey, RPh, MBA, is CEO, with the National Community Pharmacists Association.