NCPA IN ACTION

Nearly 20 gagement either helped legislators Members of Congress participating in In-District understand the role independent a pharmacy visit or in-district meeting: pharmacists play in the health care • Rep. (R-Ala.) Pharmacy Visits system, the challenges they face, • Rep. (R-Ind.) Since January and the need for legislative action, or • Rep. (D-Va.) provided pharmacy champions with • Rep. (R-Ga.) additional information and examples • Rep. John Carter (R-Tenn.) to fight for legislative remedies. • Rep. Doug Collins (R-Ga.) Since January, nearly 20 members • Rep. (R-Va.) of Congress or their staff have either There are several upcoming op- • Rep. John Duncan (R-Tenn.) staff visited an independent pharmacy or portunities to engage members • Rep. Drew Ferguson (R-Ga.) met with pharmacists in the district, of Congress while they are in the • Rep. Brian Fitzpatrick (R-Pa.) with several additional visits pending. district. Congress will be on recess • Rep. (R-Ohio) staff Some of these meetings were with for Independence Day from July 1-10, • Rep. Richard Hudson (R-N.C.) members of key committees with ju- and for its annual August recess from • Rep. Jim Jordan (R-Ohio) risdiction over independent pharma- July 29-Sept. 4. If you are interested in • Rep. (R-Mo.) cy’s legislative priorities. Others were engaging with a member during one • Rep. Tom Marino (R-Pa.) with members, including several with of these periods, visit the NCPA Advo- • Rep. Tim Murphy (R-Pa.) new members of Congress, seeking cacy Center. You can also contact Mi- • Rep. (D-Ore.) to learn more about the issues. But chael Rule at 703-838-2617 or michael. • Rep. Jose Serrano (D-N.Y.) staff in every case, this in-district en- [email protected] for assistance. • Rep. (R-Ark.).

CLARITY FOR PHARMACY COMPOUNDERS, AT LAST

A recently-enacted $1 trillion omnibus spending bill that will keep the federal government running through September includes language that clarifies congressional intent on several compound- ing regulations implemented under the Drug Quality and Security Act. This is a win for NCPA and all compounding stakeholders who have worked to protect the practice of pharmacy compound- ing. The language calls on FDA to: • Draft a new memorandum of understanding that allows pharmacies that meet all other requirements of 503A to "distribute" compounded products over state lines. Dispensed com- pounds are not to be included. • Draft new guidance to allow pharmacists to compound for "office use" in anticipation of receiving patient-specific prescriptions.

NCPA & All Compounding • Acknowledge that pharmacies compounding under 503A are under the purview of state s Stakeholder boards of pharmacy and are not to be held to current Good Manufacturing Practices. • Any final guidance on animal drug compounding must not attempt to apply Section 503A or 503B to animal drug health.

NCPA is continuing to monitor FDA activity to ensure that it is finally following the intent of Congress.

8 America’s PHARMACIST | July 2017 President Mullins’ ‘Thank You’ Tour

NCPA President DeAnn Mullins, Pharmacist, CDE, personally thanked seven lawmakers for championing independent community pharmacy legislation in a series of Capitol Hill meetings in late May. Mullins, owner of Mullins Pharmacy in Lynn Haven, Fla., met with Reps. (R-Wash.), Doug Collins (R-Ga.), (R-Fla.), Morgan Griffith (R-Va.), Dave Loebsack (D-Iowa), and Cathy McMorris Rodgers (R-Wash.) along with Sen. Shelley Moore Capito (R-W.Va.). Mullins also met with key committee and legislative staffers. Learn more about your congressional priorities in the Feder- al Advocacy section of the NCPA website.

While visiting Washington, D.C., DeAnn Mullins met with Rep. Morgan Griffith (R-Va.), and Rep. Cathy McMorris Rodgers (R-Wash.). Stateside

Georgia: Patient Protections Added, New Hampshire Legislature Passes Bill Restricting Clawbacks Defanged PBM Accreditation Powers Gov. Nathan Deal (R) has signed legislation that In New Hampshire, a bill prohibiting PBM powers prohibits copay clawbacks, mandatory mail order, and passed the state House and Senate, and is expected pharmacist gag clauses plus adds other pro-patient to be signed into law by Gov. Chris Sununu (R). provisions. HB 455 prohibits pharmacy benefit managers from requiring providers to attain accreditation, Nevada Takes on PBMs, Pharma in Drug Pricing credentialing, or licensing other than by the pharmacy Transparency Law board or other state or federal entity. In Nevada, a bipartisan bill (SB 539) was passed that will force drug manufacturers to justify price hikes TO LEARN MORE AND GET on diabetes medications, and also require PBMs to INVOLVED, VISIT THE NCPA disclose rebate information. The legislation would ADVOCACY CENTER also prohibit PBMs from punishing pharmacists for "selling a less expensive alternative drug" to patients. The bill passed both the state's Assembly and Senate and was signed into law by Gov. Brian Sandoval (R).

Oregon: Stricter PBM Regulation Gov. Kate Brown (D) has signed legislation that tightens a previous law regulating PBMs, giving enforcement authority to the Department of Consumer and Business Services to deny, revoke, or suspend registration of a PBM under certain conditions.

www.ncpanet.org/ap 9 For Your Viewing Pleasure: Don’t Miss 'The PBM Story' Video

NCPA has released a short video (three minutes) based on the print version of The PBM Story: What They Say, What They Do, and What Can Be Done About It. Download a copy from www.ncpanet.org/pbmstory or watch it on NCPA's YouTube channel. Play it in your waiting area if you're set up for that.

Please also share the link promptly with your members of Congress, your state legislators, other policymakers, local employers, and anyone else who needs to understand that there are better solutions that exist to address rising prescription drugs while still ensuring quality patient care.

Support Building for TRICARE Pilot Program to Access Lower-Cost Prescriptions

Sixty-five members of the House of Representatives have asked the Secretary of Defense to implement the TRICARE Acquisition Cost Parity Pilot Program for Retail Pharmacy, which would allow retail pharmacies PROVIDER STATUS UPDATE to purchase brand name drugs at reduced rates via voluntary manufac- turer discounts. NCPA strongly supports the program. NCPA and other members of the Patient Access to Pharmacists' Care Coalition met face-to- face with Seema Verma, new administrator of the Centers for Required Reading… Medicare & Medicaid Services, to advocate for pharmacist “Susan Hayes can’t forget the trek from the parking lot, across a dusty patch of provider status. Verma indicated Arizona desert, to a dingy building without air conditioning and through a door that she recognizes the impor- marked ‘Scorpion Room.’ ‘“Like something out of the Bates Motel,”’ said Hayes, a tance of access points to care fraud investigator for employers, unions and health plans, and a longtime [PBM] and supports the concept of industry critic. In the Scorpion Room, she pored over hundreds of pages of non- Medicare Part B pharmacist pro- public contracts between drug companies and a now-defunct pharmacy-benefit vider status. Bipartisan provider manager, a powerful middleman that processes claims and negotiates discounts status legislation, the Pharmacy and rebates.” and Medically Underserved Areas Inside the ‘Scorpion Room’ Where Drug Price Secrets Are Guarded, Enhancement Acts, has been Forbes, May 4, 2017 introduced in the House and Senate. S. 109 has 40 cospon- "If Congress finishes with the Obamacare repeal fight anytime soon and moves sors and H.R. 592 has 176. on to other health topics—cough, drug pricing—it may not be a good time to be a pharmacy benefit manager, the companies that administer health plans' prescrip- You can read about pharmacists tion drug benefits. Anti-PBM sentiment is heating up. The companies say they taking action without waiting for keep drug prices down, but all sides of the health care field are questioning how provider status in the May issue much savings they are bringing to the health sector. of America’s Pharmacist. More A Hard Week for PBMs, Prescription Pulse, May 1, 2017 information about the legislation can be found at www.ncpanet. org/advocacy. TO LEARN MORE AND GET INVOLVED, VISIT THE NCPA ADVOCACY CENTER

10 America’s PHARMACIST | July 2017 How community pharmacists wound up on the front page of The New York Times

by Kevin Schweers

“Nothing worth having comes easy,” Theodore Roos- evelt reportedly said. That sums up how NCPA mem- bers reached the front page of a national newspaper maybe two, with us, to get a couple of quotes and snap talking PBMs. some pictures. Five hours later, he was still our compan- ion before calling it a day. NCPA hosts several marquee events for you, our members, throughout the year. For NCPA staff, they After several weeks and a series of follow-up emails and are all-hands-on-deck affairs that run from early in phone calls, the Times published a lengthy, front-page the morning until late at night, affording little time to story, [http://bit.ly/ncpainnytimes] describing how hun- work on anything else. Naturally, on the eve of NCPA’s dreds of independent pharmacists came to Washington Congressional Pharmacy Fly-In with 230 communi- to argue that they are the industry’s “white hats” and to ty pharmacists, that’s when our inbox displayed an deliver messages like this: “Want to reduce prescription email from a Pulitzer Prize-winning reporter, which drug costs? Pay attention to the middlemen.” Georgia read, “Can you ring me re: your fly-in this week. community pharmacists appear prominently in pictures Thanks in advance.” accompanying the article.

We were rightly apprehensive because the reporter’s First Amendment rights apply to PBM lobbyists, too, byline was familiar: Eric Lipton of The New York Times. who made familiar arguments to Congress in opposition As its Washington lobbying reporter, he favors stories to NCPA’s key legislative priorities. However, one stood like how giant corporations sneak tiny provisions worth out: a blast email encouraging congressional staff to ask billions of dollars into federal legislation which may be “Top questions for America’s independent pharmacists,” entirely unrelated. In other words, exceptions to the ad- without identifying who sent or paid for the message. age, “There’s no such thing as bad publicity.” The Times traced it back to a Washington public relations Yet that’s where NCPA is different from many players firm, which hung up on the reporters—repeatedly—when “inside-the-beltway.” We represent front-line community asked who paid for the anti-pharmacist email. Ultimately, pharmacist small business owners looking out for their the culprit emerged: Express Scripts. patients and their neighbors. We’ve got a great story and we’re eager to tell it. Perhaps nothing more clearly captures the stark differ- ence between community pharmacists openly making Lipton asked to shadow some community pharmacists as the case for their patients and enormous PBM corpo- they made their rounds on Capitol Hill, amid a raging de- rations engaged in a covert effort to protect a secretive bate over rising prescription drug costs. Following some business model. It’s good to be on the right side of that NCPA staff discussion, we green-lighted it. The Georgia debate and breakthroughs like the Times article accom- Pharmacy Association graciously agreed to let Lipton join plish more awareness and credibility for community them and entertain his questions. pharmacists than hundreds of ads run by PBMs. ■

With shrinking budgets forcing the media to do more Kevin Schweers is director of the NCPA Advocacy Center and with less, we expected the reporter to spend an hour, senior vice president of government and public affairs.

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