By Dirk White, RPh, Executive Vice President, and Legislative Affairs Regional Leader for Alaska, WSPC
All the hot news stories out of Washington D.C. are focused on the proposed changes to the Affordable Health Care Act. The focus on the Affordable Health Care Act is normal, of course, but there is also legislation pending that is as important, if not more important, to the pharmacy profession. We can ill afford to let it get swept under the D.C. carpet by this major legislative push. It would be in our best interest to place our focus on getting the pending legislation passed.
The two bipartisan bills to focus on now are Senate (S.) 413 and House Resolution (H.R.) 1036. These bills are known as the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act. These bills, if passed, will:
- Prohibit PBMs and Part D plan sponsors from using DIR fees to claw back monies on any clean claims submitted by us under Medicare Part D plans.
- Boost drug pricing transparency in the Part D plans allowing CMS better oversight of those plans and patient premium fees.
- Continue to preserve access to our independent community pharmacies by preventing DIR rates that are resulting in more and more closures of independent pharmacies across the nation; it would also slow and hopefully stop the five-year decline in the number of rural pharmacies having to close due to such outrageous DIR rates.
- Ensure the continuation of pay-for-performance programs that reward us for meeting quality metrics that improve patient health and outcomes with proper medication use.
In January of this year, CMS stated that the rise in the use and size of DIR fees to pharmacies is increasing Medicare costs and forcing more of our patients into the Medicare D Part D coverage gap (also known as the “donut hole”). The rise in costs is causing more of our patients to try and figure out what medications they can afford while the PBM/Plans save on the expense of that patient’s medications by in turn causing CMS to bear those larger catastrophic costs. We all know that DIR fees are cutting into our margins. DIR fees affect not only our ability to continue some of the special services we provide at no extra cost to our patients, but also our very ability to keep the lights on in our pharmacies.
When a local surgeon retired here a couple of years back, I asked him why he retired, because I knew he wasn’t of “retirement age.” He said he was tired of working for the insurance companies. That statement could be changed and used by some of the pharmacists that have closed their doors too: “They were tired of working for the PBMs.”
Well, then what can we do to keep providing our critical healthcare services to our communities? Please:
- Call and email your senators now to tell them they need to vote yes on Senate (S.) 413.
- Call and email your house representatives now to tell them they need to vote yes on and House Resolution (H.R.) 1036.
If you don’t know who your House Representative is or how to contact them, you can go to www.house.gov/representatives/find/. If you know their name, you can always search for their contact information on the internet through your favorite browser.
If you don’t know how to contact your Senators, you can find them at www.senate.gov/senators/contact/. If you know their names, you can search for their contact info online through your browser of choice.
When contacting your Senators and House Representatives, be sure to start your communication with your name and family members’ names and that you are a pharmacist or pharmacy owner. Remind them that you are their constituent and that you employ X number of employees in their district with an annual payroll into your community of $X, XXX, XXX.XX every year. Tell them that you provide your employees all of these X benefits from your ongoing operation. If you live in a rural location, tell them how far the nearest independent and chain pharmacies are to your community and how large a patient base you serve, the local population, and, if appropriate, the square miles that your pharmacy serves. Include anything that you do in or outside your pharmacy that helps improve your community health and well being, such as increasing access to critical health care like immunizations, diabetic training, and counseling.
We are all primary gateways to the healthcare system. A community that lacks a pharmacy tends to use the hospital emergency room as a very expensive gateway. We need to blow our horn and let our elected officials know how important we are in the overall scheme of this crazy world of health care in which we operate. Congress needs to know how DIR fees are killing independent pharmacies and that it needs to stop now.
It is obvious to me that, in-order-to be successful in independent pharmacy now and in the future, we need to stay active in local and federal politics! There are many other bills in Congress that directly affect pharmacy that needs addressing, but Senate (S.) 413 and House Resolution (H.R.) 1036 are the most critical bills that we need to get passed now.