Pharmacy State of the Union–May 2018

May 18, 2018
USCapital2018 has been bursting with activity in Washington, D.C. and state legislatures related to drug pricing, opioid epidemic, PBM reforms, 340B, and Medicaid and Medicare reimbursement. In April, hundreds of community pharmacists visited Washington, D.C. to advocate for pharmacy priorities via NCPA's annual Congressional Pharmacy Summit. Following NCPA's hill day, several pharmacy bills received increased co-sponsorship due to effective pharmacy advocacy. Click here to review NCPA's outline of updates in co-sponsorship of priority legislation.

Drug Pricing Activity

On Friday, May 11th, President Trump and Health and Human Services (HHS) Secretary Azar announced their blueprint to lower prescription drug prices in the U.S. The "American Patients First" blueprint can be viewed here. Secretary Azar has specified four "challenges" contributing to high drug prices including: 1)  high list prices; 2) seniors and government programs overpaying for drugs due to lack of negotiation tools; 3) high and rising out-of-pocket costs for consumers; and 4) foreign government "free-riding" off of American investment in innovation.

The administration plans to address these challenges via strategies aimed to 1) improve competition; 2) better negotiate; 3) incentivize for lower list prices; and 4) lower out-of-pocket costs.

The President & Secretary Azar's plan to lower drug costs will include two phases including actions the President may direct HHS to take immediately and actions HHS is considering - will include requests for feedback and information.

The blueprint includes several pro-independent and long-term care pharmacy policies both community pharmacists and long-term care pharmacists have been advocating for in Congress and in the Administration:

• DIR Fees: Proposal includes the idea of eliminating rebates so a flat price is in place. HHS issued a request for information regarding this idea and would like to hear from pharmacy advocates on this proposal.

• Ways for PBMs to act in best interest of patients & payers: the Administration is looking at ways to increase transparency in this part of the supply-chain including PBMs to potentially have fiduciary obligations.

• Gag Clauses: CMS sent a memo on May 17 to all Medicare Part D Plans stating gag clauses are now banned. Click here for a detailed update.

State Drug Pricing Activity

Several states would like to see pharmaceutical manufacturers disclose drug-pricing information and/or be charged penalties for price increases.  Several states have also shifted their focus to PBMs and their role in the supply chain and in drug pricing.  

AmerisourceBergen subsidiary, Xcenda, has been tracking state drug-pricing bills and issued a policy report which can be viewed here.

Congress & States Focus on Legislation to Address Opioid Epidemic

Congress & state legislatures are actively drafting, marking-up and passing various legislative proposals this year to address the opioid epidemic.

In the states, several legislatures have passed bills to change or limit prescribing policies as one method of addressing the opioid epidemic. The National Conference of State Legislatures (NCSL) has a helpful summary outlining actions the states have taken with regards to prescribing practices.

Since last October, Congress has conducted 28 hearings across 8 different House and Senate committees focused on the opioid crisis, including 5 just last week and many more to come. In May, the U.S. House Energy & Commerce Committee advanced 57 bipartisan bills to address the opioid epidemic. One of these bills was The Every Prescription Conveyed Securely Act sponsored by Reps. Markwayne Mullin (R-OK) and Katherine Clark (D-MA) which would require electronic prescribing for Schedule II through V controlled substances prescriptions covered under Medicare Part D to help prevent fraud, abuse and waste. ABC supports this legislation, along with NCPA, NACDS and HDA. On May 16th, the U.S. House Ways and Means Committee advanced 7 bipartisan bills to help address the opioid crisis – several intended to prevent future misuse of prescription opioids among seniors and to make addiction treatment more readily available to Medicare beneficiaries. In late April, the Senate HELP Committee unanimously passed S. 2680, the Opioid Crisis Response Act of 2018, their version of opioid solution legislation focused on prevention, treatment and research. The Senate HELP committee released this statement after passing their bipartisan bill.

Additional House and Senate Committees with jurisdiction over opioid legislation are continuing to work through process to bring legislation to the House and Senate floor. Congress is tentatively aiming to pass legislation before the November election.  Several pharmacy organizations, including NCPA, APHA, SCPC and NACDS, are actively working with lawmakers as they develop legislative solutions to address the opioid epidemic.

2018 Pharmacy Action & Advancement in the States

A high volume of activity related to pharmacy priority issues is taking place in the states this year. NCPA recently issued a helpful summary outlining several state successes achieved this year related to PBM reform and Medicaid reimbursement. Participation in NCPA and state pharmacy associations is a pivotal way for pharmacists to become involved and make their voices heard on pharmacy priorities. 

ABC Government Affairs encourages you to join NCPA and your state pharmacy association to become involved in issues that matter most to you and your patients! Please take time to read about the 2018 state legislative successes NCPA highlights on their website.

ABC supports NCPA, NASPA, NACDS, SCPC, APHA and several state pharmacy associations through corporate partnerships and/or collaboration with their government affairs teams on legislative initiatives to amplify the voice of the pharmacist and to have the most impact with ongoing advocacy efforts.