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.

PC encourages all members to contact Rep. Doug Collins (R-GA) and thank him for his recent efforts to stand up for independent pharmacies nationwide. He recently submitted an inspiring letter to the editor which was published in the Wall Street Journal. Please contact the Congressman’s Office and convey your appreciation for his support of independent pharmacy: His office number is 202-225-9893 in Washington.

CMS decided to “kick the can down the road” on DIR fees at this time, but noted that the President’s Fiscal Year 2019 Budget included language that all price concessions should be at the point-of-sale. CMS believes the statute provides them with discretion to require that Part D sponsors apply at least a portion of the manufacturer rebates and all pharmacy price concessions they receive to the price of a Part D drug at the point of sale. Any new requirements regarding the application of rebates at the point of sale will be proposed through notice and comment in future rulemaking.

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.

We are in the final stages of the legislative process for AB 315 (Wood, Dahle, Nazarian & Stone) which would require that Pharmacy Benefit Managers (PBMs) be regulated by the California Department of Managed Health Care (DMHC). Voting will take place as early as Monday, August 27th.

IPC Chairman of the Board, Chris Darling, recently had a visit from Congressman Glenn Thompson!