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News & Press: National News

Executive Update from NCPA

Thursday, October 5, 2017   (0 Comments)
Posted by: Janet Anderson
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September 29, 2017

A $3.4 Billion Game-Changer

Dear Colleague,

Doug HoeyThe last few weekends have been exciting ones in college football. Each week so far, there's been at least one match-up (and last weekend, three) in which one team, down for the first three quarters, has executed a breathtaking comeback in the fourth quarter.

UCLA in an improbable comeback against Texas A&M. Penn State over Iowa with a last-second touchdown. Florida, on successive weekends, scoring with seconds left on the clock to beat both Tennessee and Kentucky. And my alma mater, the University of Oklahoma, giving me palpitations against Baylor until a freshman running back named Trey Sermon scored two come-from-behind touchdowns. Whew.

Sermon was a game-changer. So was Florida's Hail Mary against Tennessee. And Penn State's walk-off touchdown as time ran out.

But college football stadiums aren't the only place you could see a game-changer this past week. Yesterday, NCPA announced a game-change of our own, and I suspect you'll find it far more important to your pharmacy business than a football game.

Though it's still early, and we're far from down on the scoreboard, I believe the research we introduced yesterday should change the dimensions of the debate over retroactive pharmacy DIR fees and the federal legislation we're supporting that would ban them.

The legislation — a top NCPA member priority — is the "Improving Transparency and Accuracy in Medicare Part D Drug Spending Act" (S. 413 / H.R. 1038), which will prohibit Medicare Part D plan sponsors/PBMs from retroactively reducing payment on clean claims submitted by pharmacies under Medicare Part D.

The new research — commissioned by NCPA and prepared by Wakely Consulting Group, one of the top actuarial firms in the country — establishes a private score for that bill. "Score" is Washington-speak for how much passing the legislation will cost or save the federal government. Knowing that score is often essential to whether a piece of legislation will advance in Congress. Bills with significant price tags almost always have a tougher go of it.

But for the pharmacy DIR bills, the news is good. Not just good, but great — a real game-changer. The Wakely research shows that eliminating retroactive pharmacy payment reductions — or post point-of-sale pharmacy "DIR fees" — in Medicare Part D would save the federal government $3.4 billion over 10 years.

In case you missed it, that's billion with a "B." It almost goes without saying that this Wakely study is vitally important in showing that DIR legislation will result in extraordinary taxpayer savings without subtracting any benefits seniors currently receive. And for pharmacies like yours, banning these after-the-fact fees is the fair way to achieve predictability in reimbursements for the medications you buy and dispense.

This Wakely research also supports a January 2017 analysis by the Centers for Medicare & Medicaid Services showing that DIR fees on pharmacies do not reduce the cost of drugs for beneficiaries at the point of sale and in fact push seniors into the 'donut hole,' and, subsequently, the catastrophic phase of the Part D benefit faster.

So: Good news. Game-changing news. But the game's really just started. You can help by sharing with your member of Congress the news of this DIR bill score and asking him or her to cosponsor the bill. You'll find our news release on it here. You can also contact NCPA's Michael Rule for additional information and tips for scheduling a meeting with your member of Congress.

Together, we can change PBMs' retroactive DIR fee game. Thanks in advance for your support.

Doug Hoey

P.S. Speaking of game-changers, you'll find plenty for your pharmacy business at the NCPA Annual Convention in Orlando, Fla. next month. Even with this new analysis from Wakely, it's still important to educate yourself about marketplace tools to mitigate DIRs' impact on your business. We have a session on that topic and many others, such as personnel, specialty pharmacy, marketing, and more. But you need to be there! Take a moment to register now — the deadline to claim your $100 discount on on-site rates ends next Friday, Oct. 6.

more Calendar

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Webinar: URAC’s Specialty Pharmacy Accreditation

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