'Pharmacists have never been more popular.'

ARLINGTON, Va. — Momentum for pro-pharmacy legislation is building in both political parties and in both houses of Congress, as the industry’s invaluable role during the pandemic continues to shape the views of lawmakers and the public.

“There’s a lot going on, and it’s bipartisan and bicameral,” says Steve Anderson, president and chief executive officer of the National Association of Chain Drug Stores. “And it’s a direct result of what pharmacy has done over the last three years. We opened up the economy and the country amid COVID. The numbers are pretty staggering right now in terms of vaccinations. I’ll ask any member of Congress where they got their COVID shots, and most — if not all — will say at an NACDS member pharmacy.”

Steve Anderson

More than 301 million COVID vaccinations have been provided by pharmacists to date, not including millions administered through various state programs. Anderson cites a study published in the Journal of the American Pharmacists Association, which found that pharmacists and pharmacy teams are responsible for 1 million lives saved, 8 million hospitalizations prevented and $450 billion in health care costs saved. “So all that hard work we put in over the last few years really paid off in terms of what our members accomplished and what the association did on the policy side.”

Bills are emerging on pharmacist provider status and PBM reform. Among the most recent developments is newly introduced legislation to crack down on tactics by which “pharmaceutical benefit manipulator” middlemen maximize profits at the expense of patients, pharmacies and others: the Drug Pricing Transparency in Medicaid Act. H.R. 1613, introduced in March by Reps. Buddy Carter (R., Ga.), Vicente Gonzalez (D., Texas), Elise Stefanik (R., N.Y.), Deborah Ross (D., N.C.), Rick Allen (R., Ga.), and Jake Auchincloss (D.,Mass.), and S. 1038, introduced in April by Sens. Peter Welch (D., Vt.) and Roger Marshall (R., Kan). That legislation would block middlemen tactics in Medicaid managed care that drive up prescription drug prices and force pharmacies to provide medications below the cost of acquiring and dispensing them.

Also, the Senate Finance Committee held a hearing exploring the tactics and the practices of the PBMs and the impact that middlemen have on patients, pharmacies, employers, “and really on the broader health care system,” notes Anderson.

PBM abuses have become an existential issue for the pharmacy industry, he says. “There’s an epidemic of pharmacy closures in this country, and we need to move quickly on this before we have more pharmacies going out of business. Even President Biden is repeating our message that 90% of Americans live within five miles of a pharmacy. But when those pharmacies are closing — particularly in underserved areas in rural and urban spaces — we can’t provide all these great services for the American people.”

To help achieve truly comprehensive PBM reform, NACDS is pressing for a complete array of reform principles. NACDS emphasizes its full slate of principles when it comments on one piece of legislation to emphasize that a bill may be necessary but not sufficient to meet the needs of patients and pharmacies.

Aside from scrutiny of PBMs, the Equitable Community Access to Pharmacist Services Act, H.R. 1770, more commonly known as provider status legislation, continues to gain support. The bill is crucial to pharmacies that face numerous payment barriers and gaps in working to serve Medicare patients, says Anderson. As things stand, there’s no reimbursement mechanism, or pathway for pharmacies to bill for clinical services under Medicare Part B, he explains. Pharmacists have had to surmount hurdles to be reimbursed for a host of offerings including clinical services, testing, vaccine administration and antiviral assessments.

As to when various bills could be passed, Anderson expects some results during this Congress, which runs through 2024. He says that “while a lot gets teed up, it’s all driven by politics.”

(Left to right) Anderson with NACDS board members Kevin Host of Walmart, Martin Otto of H-E-B, Rick Gates of Walgreens, Karen Staniforth of Rite Aid, Bob Narveson of Thrifty White, and outgoing chair Brian Nightengale of Good Neighbor Pharmacy.

But as polarized as the country and lawmakers are, he says NACDS works indefatigably to make sure its issues are bipartisan, or nonpartisan. “That gives us a pathway to enact bills. And I’m very optimistic.”

He has especially high hopes for reform of PBMs’ DIR (direct and indirect remuneration) fees and the provider status bill. “The feedback coming to us and the actions that we’re getting with bill introductions — but more importantly with the hearings being held — show progress.”

Also of great consequence to the industry is the Federal Trade Commission’s study of PBMs. “We had asked the FTC to investigate them, and we’re pleased that it is,” Anderson comments. “So we’re working very closely with our members to make sure we’re being responsive to the FTC. We’ve been answering questions that they already have about PBMs, and we’re suggesting ones that they should be asking that may not have occurred to them.” NACDS is simultaneously propelling the investigation in Congress, engaging with the House Oversight and Reform committee on its own PBM probe. The panel is “casting a pretty wide net,” so NACDS is meeting with both members and their staffs to make sure that they’re “looking at the right things as well.”

The actions of the committee and FTC reflect “the bipartisan nature of the issue,” given that Republicans and Democrats serve on the House panel, and that while the regulatory body’s chair was appointed by Biden, GOP and Democratic members voted unanimously to proceed with the investigation.

When the FTC might take action is unclear, says Anderson, noting that the regulators do a thorough job. “They are, and will be, seeking information. They have subpoena authority. So they will be requesting documents and compliance, and the review and compilation of those documents can be rather daunting. We’re actually hoping something will happen this year. Even if they haven’t completed their investigation on an interim basis, they might issue some statements.”

The commission has broad powers, including the authority to change corporate structures, and retract government approvals of mergers and acquisitions. It can also recommend congressional legislation. “The important thing is that they get as much information as they can that’s relevant to the subject matter,” says Anderson. “No matter what the PBMs may give them, we have to keep the focus — both at the agency and on the Hill on their investigation. And it’s interesting because we’ve made such great progress by NACDS working with our various allies that we have on all these issues. We’ve done a really great job educating members of Congress, and so they’re hitting the ground running because they already know the issues. I can remember being on the Hill a couple years ago and trying to explain what PBMs and DIR fees are, and eyes would start to glaze over. That’s not the case anymore.”

Congress’ direction on DIR fees remains to be seen, but NACDS has some solid backers, including Senate Finance Committee chairman Ron Wyden (D., Ore.), who has been “one of our great champions.”

In the states, the industry is still riding the wave of the Supreme Court’s unanimous late 2020 decision in Rutledge v. Pharmaceutical Care Management Association that federal legislation doesn’t preempt state laws regulating PBMs. “There’s been a flood of state PBM measures that have been introduced and enacted just in the last couple years,” Anderson points out. “We’re seeing the goodwill towards pharmacy spreading, not only in Congress, but in the state legislatures, which are closer to people than the U.S. House and the U.S. Senate. So we’re in a great position to leverage a lot of these issues.”

With the public health emergency ending on May 11, lawmakers might be a little weary of dealing with COVID issues, and NACDS wants to ensure there is no rollback of pandemic measures that empower patients’ access to pharmacy services. That shouldn’t be a problem for the public and in the states. Anderson was at the National Governors Association meeting in Washington, D.C. last month and he talked to a lot of governors. “And it was stunning how much they knew about what pharmacists did — I mean in great detail. They can remember meetings that they had with pharmacists and our member companies on what needed to be done in their states.”

As far as the public is concerned, a poll by Morning Consult, commissioned by NACDS and conducted in December, found that 64% of American adults — including majorities of Republicans, Democrats, and independents — believe “Learning the lessons of the pandemic means keeping in place policies that make it easier for patients to access services from pharmacists and other pharmacy team members — including vaccinations.”

Among those 65 years and older, the level of support jumps to 77%. Also, 86% of adults — and an amazing 96% of those 65 years and older — say it is “very easy” or “somewhat easy” to access pharmacies, making them the most accessible health care destination tested.

“Pharmacists have never been more popular,” Anderson remarks. “They’ve never polled at the numbers that we’re seeing here. It’s a result of what our member companies and the association have accomplished.”

He recalls NACDS’ ad from April 2020 saying that pharmacies’ lights were on and doors were open, and that pharmacists were going to be leaders in ending the pandemic. “We had pictures of what would be historic times of pharmacists stepping up to the plate on behalf of the nation. It’s so interesting to go back and look at that, because our members kept the ad’s promise. It really was prophetic in terms of the role pharmacy was going to play. It required a lot of work on the part of everyone in the industry to fulfill that role. And they did it. And many members of Congress saw it firsthand when they got their COVID shots at member company stores.”

That’s a promising backdrop as the 2023 NACDS Annual Meeting gets under way. Attendance at last year’s event was almost at pre-pandemic levels, and registration this year “was through the roof,” says Anderson. “It’s going to be a great meeting. We have a lot to talk about and we need to make sure this industry stays united and keeps fighting for these issues.”

Anderson, who is the immediate past chair of the American Society of Association Executives, says many organizations have been having trouble getting people back to their meetings. “We don’t have that problem, because there was great appeal for the Annual Meeting going into the pandemic. As a result, people wanted to get back together. We provided value pre-pandemic, and that has driven attendance both last year, and now this year. It bodes very well for us moving forward.”