Independent Thoughts


The Voice of Independent Community and Compounding Pharmacists 

The Alliance is directed by independent community pharmacists and is not obligated or tied to one single buying group or wholesaler. We are working to pass substantive legislation that makes a difference in your small business and community. 

July 26, 2019

Alliance News 

Join us for the Independent Pharmacists’ Reception August 2 in Las Colinas 

All independent pharmacists are invited to join us for a reception in conjunction with TPA’s Annual Conference & Expo Friday, August 2 at 7:30 p.m. The reception will be held at the Westin Irving Convention Center at Las Colinas, Melody 3 Meeting Room.  

Plan to come and stay for dinner—drinks, heavy hors d'oeuvres, and dessert will be served. RSVP to Ashley Bishop at [email protected].  

Agency News 

Vendor Drug Hosts Pharmacy Quarterly Stakeholder Meeting this Week

The HHSC Texas Vendor Drug Program hosted its quarterly pharmacy stakeholder meeting on Wednesday this week in Austin.

Alliance CEO Audra Conwell attended the meeting, along with pharmacy stakeholders from Texas Pharmacy Association, Texas Pharmacy Business Council, and National Association of Chain Drug Stores (NACDS).

VDP staff notable updates included: 

  • Pharmacy online enrollment
  • VDP interpretation of legislation passed during the 86th Texas Legislative Session
  • Pharmacy reimbursable services

Pharmacy online enrollment will consolidate provider enrollment from multiple departments within HHSC providing a central depository. The online process will eliminate paper enrollment and hopefully streamline the process for Medicaid providers. VDP staff were unable to provide a definitive date when the program will be available for use. Staff noted that pharmacies must still contract with MCOs separately and follow their credentialing guidelines.

VDP Pharmacy and MCO Oversight Director Priscilla Parrilla provided a legislative update outlining all of the legislation and riders passed last session that must be implemented through the agency. Legislation of note includes:

  • HB 3285, which removes non-preferred prior authorizations from medication assisted therapy (MAT) drugs to treat opioid and substance abuse disorders.
  • SB 1096, which provides continued access to drugs prescribed to a child enrolled in STAR Kids, regardless of whether the drug is on the VDP formulary and prohibits non-preferred prior authorizations and step therapy protocols for this population. VDP staff has indicated they will not implement on the September 1 implementation date because they must ask CMS for approval.
  • Rider 29 requires HHSC to automate and streamline the process to add drugs to the formulary.
  • Rider 30 requires VDP to evaluate strategies to achieve cost savings or Medicaid prescription drugs by including direct dispensing of prescription drugs by physicians. Findings must be reported by September 2020.

As you will recall, the Alliance passed Rider 23 in 2017 requiring the agency to evaluate pharmacy service delivery models to increase patient access and create cost savings to Medicaid. As a result, effective September 1 pharmacies will be reimbursed through the pharmacy benefit for ingredient costs, dispensing fee, and administration fee for long-acting antipsychotic medications and Vivitrol. In addition, reimbursements for ingredient costs and administration fees will be paid for the flu vaccine.

To ensure reimbursement of long-acting injectable antipsychotics and Vivitrol pharmacists must have a valid prescription required from a Medicaid/ACA enrolled prescribing provider and both the pharmacists and the prescribers provider’s NPI on the claim. Pharmacists are not required to be enrolled with VDP.

To ensure reimbursement for flu vaccines there must be written protocol or standing order from a Medicaid/ACA enrolled prescribing provider, pharmacist and prescriber NPI on the claim, and pharmacists must follow TSBP requirements regarding certified immunizer. The pharmacist does not need to be enrolled in VDP and the vaccine will not count toward the patient’s three-script limit.

For more information visit Texas Vendor Drug

TDI Updates Rules Related to URA Decisions, Appeals

The Texas Department of Insurance has updated its rules related to notice of, and appeals of, decisions made by utilization review agents (URAs). The agency says the updates were needed to align TDI rules with legislation passed in 2015 and 2017. You can read more about the TDI updated rules here.

The amended rules require a URA to notify individuals covered by an insurance policy of their right to immediate review of the URA's denial of prescription drugs or intravenous infusions for which they are receiving benefits under the health insurance policy. The URA must also provide a method for an expedited appeal. TDI has also added a requirement saying a URA's written procedures must provide that someone denied the provision of prescription drugs or intravenous infusions for which the patient is receiving insurance benefits is entitled to an immediate appeal to an IRO.

National News 

Senate Finance Committee Takes First Step in Drug Pricing Package

On Thursday, the Senate Finance Committee passed the drug pricing package out of committee on a 19-9 vote. The markup is the first step to reforming pharmacy DIR fees and standardizing pharmacy quality. On Thursday, 

  • Sen. Sherrod Brown (D-Ohio) introduced an amendment with support from Sens. Bill Cassidy (R-La.), James Lankford (R-Okla.), Tom Carper (D-Del.), Maggie Hassan (D-N.H.), and Steve Daines (R-Mont.) that would have prohibited retroactive DIR fees. Brown withdrew the amendment, but not before getting a strong commitment to address DIR during the legislative process from both Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.).
  • The bill does include a provision which requires HHS to establish a standardized pharmacy quality metrics program in Part D. It also includes many positive developments regarding public disclosure of PBM data and prohibiting all Medicaid spread.
Article Highlights Ways PBMs Claw Back Dollars from Pharmacies

In a major article this week, the national online news source Axios highlighted ways that Express Scripts and other PBMs retroactively claw back millions of dollars from pharmacies . You can read it here.

The Axios article says, “Express Scripts, which manages pharmacy benefits for roughly 100 million people, claws back millions of dollars per year from pharmacies after prescriptions go out the doors, according to a contract obtained by Axios. Even high-quality pharmacies have to pay back some of their revenues to Express Scripts. That arrangement highlights pharmacy benefit managers' power over the supply chain and helps explain why pharmacies have intensified their acrimony toward PBMs lately. The contract applies to Express Scripts' Medicare plans and the pharmacies that participate in its network. . . .There's little transparency into how pharmacies are scored, pharmacies don't have any control over the terms, and even high-quality pharmacies are penalized.”

Please consider sharing this article with your representatives in the U.S. Congress and the Texas Legislature. 

 

 

Support IPRX PAC

We need your HELP building our Political Action Committee (PAC) funds! As we move into the campaign season we need your financial support of the independent pharmacist's PAC (IPRX PAC). We have several events planned to provide financial support and education to pharmacy and small-business friendly candidates and we need your support, so we can give to as many candidates as possible. Contribute Now!

Remember PAC contributions should be personal and not from an incorporated business.

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Your Staff

Audra L. Conwell, CAE
Executive Director/CEO
(512) 413-4088

Ashley Bishop, CPhT
Membership Director

Honorable Jaime Capelo
Legislative Consultant

Robert Culley
Legislative Consultant

Jason Embry
New West Communications

 


 

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Independent Thoughts is the 
e-newsletter of the Alliance of Independent Pharmacists of Texas. 
 

 

 

 

P.O. Box 170323 | Austin, TX 78717 | (512) 260-7986  |  www.aiptexas.org