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The 2015 NCPA legislative game plan


Certain aspects of sporting events are similar to governmental advocacy. In both instances there are winners and losers. While many factors determine the outcome, the victor usually does a better job of executing their game plan. For example, in this year’s Super Bowl between the New England Patriots and Seattle Seahawks a game-saving interception by a Patriots defender was the result of tremendous preparation and effort combined with a play calling misstep by the opponent. Anything less and the Seahawks likely wins the game.  


Independent community pharmacies have been engaged in a prolonged, multifaceted battle to continue serving patients despite the interference of giant pharmacy benefit managers (PBMs) that administer prescription drug plans. The lack of government oversight enables PBMs to play a one-sided game often at the expense of everyone else, especially community pharmacies. To level the playing field community pharmacies must convince government officials to adopt regulatory or legislative solutions, while the PBMs only have to maintain the status quo. 


What’s the best strategy for community pharmacies to achieve their objectives? 


First, prioritize. While there are no shortage of challenges, identifying the items of most importance to the membership with the best odds of being changed on the legislative and regulatory “wish list” can ensure they receive more time and resources. Second, offer pro-patient fixes which are based on a simple premise – if you enact fair-minded policies that allow pharmacy small business owners to compete then patients will see their access to quality prescription drug services expand, as oppose to contract.


The National Community Pharmacy Association (NCPA) represents America’s approximately 23,000 community pharmacies and their patients. While we are guided by the NCPA board comprised of pharmacy owners from across the country, NCPA wanted to get insight from a larger pool of our members in helping to set our 2015 priorities.


Consequently, NCPA asked our members to identify their most pressing public policy concerns. The top two issues were achieving more transparent and frequently updated MAC reimbursement benchmark for pharmacies (particularly for multi-source generic prescription drugs that experience sudden, dramatic price spikes but for which it takes PBMs weeks or months to update reimbursement); and incorporating an effective “any willing pharmacy” provision for Medicare Part D’s "preferred pharmacy" plans. These results come just in time for the start of the 114th U.S. Congress’ two-year session. 


So far, we are off to a fast start. The recently-introduced H.R. 244, The MAC Transparency Act, would go a long way toward ensuring that PBMs reimburse community pharmacies more equitably for generic drugs. The bill would expand on and codify a requirement Medicare will be implementing for the 2016 plan year at NCPA’s request – that Part D plans update reimbursement benchmarks, such as maximum allowable cost (MAC) every seven days. Also just introduced is H.R. 793, The Ensuring Seniors Access to Local Pharmacies Act, which would implement an “any willing pharmacy” provision to preferred pharmacy networks in medically underserved areas. 


We are hopeful these two important priorities can be addressed before the 114th Congress adjourns in late 2016, but it will take a considerable, unified and coordinated effort from NCPA, its members and other pharmacy allies to prevail against the inevitable push-back from PBMs. Let’s make the plays to win our legislative Super Bowl. 


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