Pharmacy needs payment reform to thrive. We’re fighting for it on two fronts.
This week marked the end of my first year as CEO of APhA. From the moment I stepped into APhA headquarters, the World Home of Pharmacy, I was humbled by this amazing organization and all that APhA has accomplished in its 169-year history. I take very seriously the responsibility that comes with leading this storied institution. I've never doubted that the members of this profession had the mettle to look a dragon in the eye and slay it, but this year I've watched that talent and fortitude in action, and it's perhaps the most unforgettable sight of my life. The honor of supporting and advocating for our pharmacy heroes has changed my life forever, and together, we’re changing the world for good.
Thank you to my APhA team for riding this wild wave alongside me, our members and volunteers for fueling the engines of progress, and every pharmacist—everyone on pharmacy teams—for proving our message correct: The health care system can't afford to overlook us. Pharmacy is public health infrastructure.
And just last week I got some fantastic anniversary presents! If you know me, you know my top pharmacy priorities: payment reform, payment reform, and payment reform. Well, my friends, it’s on! Along with our heavy push for the passage of federal provider status recognition legislation, APhA has joined a lawsuit to end retroactive DIR fees.
In court
Let’s talk about this lawsuit, NCPA v Becerra. NCPA originally filed the federal suit in January 2021, and last week APhA signed on to become equal partners in the case. You can learn more of the legal nitty gritty on our lawsuit website, but it boils down to this: HHS opened a loophole that allowed PBMs to extract billions from pharmacies without passing savings along to Medicare Part D beneficiaries. HHS openly admits it was a huge mistake—and yet, it has repeatedly shirked its responsibility to fix the problem.
Our diseased payment system has let this go on far too long, and too many APhA members are suffering. Pharmacies and the patients they serve cannot tolerate a system in which PBMs profit by destabilizing businesses—the impact has been fatal to many of them—and threatening access to care from a long-trusted pharmacist. They are crying for justice. With this lawsuit, we demand that HHS do the right thing and move retroactive DIR fees to point of sale, like it does for other price concessions. It’s not a perfect solution, but at least pharmacies will know their actual reimbursement up front.
There’s a long road to travel before this reaches a conclusion, but APhA will inform you about every development. Watch this space!
In Congress
We’re taking retroactive DIR fees to court to claim the relief we’ve been denied, but we’re not backing down on the other major plank of our payment reform efforts: federal provider status recognition.
APhA members and staff are already working their connections on Capitol Hill to get federal provider status legislation across the finish line—and we want you to be a provider status advocate, too. This is our chance to erase a major perversity in our payment system.
In some communities, pharmacists are either the only health care provider or the only accessible health care provider. When the legislation passes, Medicare beneficiaries in these areas will gain access to the same pharmacist-provided care services that are already available to patients covered by Medicaid and commercial plans.
It’s a commonsense solution, but key to its success is pharmacy reimbursement. Pharmacists are ready to provide underserved Medicare patients with services they’re trained, qualified, and authorized to deliver, but without compensation, that’s not sustainable. When we win provider status recognition, we’ll be able to bill Medicare for the care we offer in medically underserved communities.
We know it’s possible. The states are absolutely killing it on expanded scope of practice and pharmacist payment. Thanks to the hard work of our brothers and sisters in state pharmacy associations, many payers have woken up to the value of pharmacists’ services and now compensate them fairly. States are proving that investing in pharmacists’ care is good for patients and the bottom line. Congress and the feds at Medicare need to catch up and implement this nationwide!
Stay connected with APhA for the latest on provider status and opportunities to join the fight for the recognition that pharmacists and patients deserve.
Charging on
We’re throwing down the gauntlet in Congress and in court. I’d say we were driving to restore sanity to our dysfunctional payment system if the system had ever been sane in the first place, but now is the time to set this twisted thing straight. We can’t back down—we must win. Our patients’ lives depend on it.
APhA is giving everything we’ve got to make real change for our members, their patients, and the pharmacy profession. We are fighting for you.