On March 7, 2019, the Centers for Medicare & Medicaid Services (CMS) announces plans to consolidate the competitive bidding areas (CBAs) included in the Round 2 Recompete and Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program into a single round of competition named Round 2021. Round 2021 contracts are scheduled to become effective on January 1, 2021, and extend through December 31, 2023.

The proposed regulation would exclude rebates from safe harbor protections that currently protect drug manufacturers’ rebates from penalties under the federal Anti-Kickback Statute, and would create a new safe harbor for discounts offered direct to patients, as well as fixed-fee service arrangements between drug manufacturers and PBMs.

On October 10th, the U.S. Justice Department’s Antitrust Division announce its approval of the $67 billion acquisition of Aetna, the third largest U.S. health care insurer (covering 23 million lives) by CVS Health, the largest U.S. PBM, mail order and chain drug store corporation (covering 94 million pharmacy patient and 27 percent of all U.S. prescriptions). This combination operating under CVS control is promoting their value as one stop shopping for a coordinated health care option with over 1,100 Medic-clinics in CVS’ s 9800 stores nationwide. Plans have been announced since the merger approval to expand the number CVS in-store medical clinics. The only condition on the merger was for Aetna to sell its stand-alone Part D plan, which it has already announced with its sale to Wellpoint.

As outlined in California's State Plan Amendment 17-002, DHCS is implementing a new FFS reimbursement methodology for covered outpatient drugs. Barring unforeseen delay, DHCS anticipates FFS pharmacy providers will see the new reimbursement methodology reflected in their claims with dates of service starting February 23, 2019. Because the policy effective date mandated by CMS is April 1, 2017, DHCS intends to make retroactive adjustments for all claims with dates of service between April 1, 2017, and the implementation date.

IPC’s Government Relations team encourages members in the Texas area to attend the Texas Pharmacy Day at the Capital. The event will take place Tuesday, February 26th at First United Methodist Church in Austin, Texas. Presented by the Alliance of Independent Pharmacists of Texas, the goal is to unite multiple independent pharmacy interests on legislative and regulatory issues, while promoting the profession. Register online at www.aiptexas.org today!

State Medicaid programs, now in their second year of utilizing the federally mandated program to pay for Medicaid fee for service (FFS) prescription claims of an actual acquisition cost (AAC) for the drug ingredient (mostly federal NADAC pricing) and a survey-based, cost to dispense (COD) professional dispensing fee (PDF), are beginning the process this year to survey pharmacies of their Medicaid prescription dispensing costs to update their COD fee. Many states have state laws to require pharmacies to participate in these surveys which occur usually every two years.