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May 7, 2018

Provider Status and Opioids Legislation Update

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I WOULD LIKE TO UPDATE YOU on ASHP’s ongoing efforts to advocate for passage of legislation that would recognize pharmacists as patient care providers in the Medicare program, as well as legislative efforts related to the opioid epidemic.

As the 115th Congress begins to shift focus to the November elections, opportunities for healthcare legislation are limited. We anticipate that any healthcare-related legislation will be mainly focused on the opioid epidemic. As a lead member of the Patient Access to Pharmacists’ Care Coalition, ASHP is working to determine ways in which provider status language might be addressed in the pending opioid bills. However, given that the focus of these bills is mainly on opioids, our efforts for now may need to shift to articulating how pharmacists can play important roles in helping to solve this major public health problem.

Efforts to obtain provider status are part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time. Our intent is to enhance our members’ ability to provide care as part of the interprofessional patient care team.

As states look to expand their scope of practice laws to promote the direct patient care roles of pharmacists, ASHP is supporting state-level efforts of our members and working at the federal level to include these direct patient care roles in Medicare. We also want to make sure our members are well-positioned to align their efforts with Medicare modernization, which is now focused on moving toward value-based models that align payment with quality and outcomes. ASHP members are in an excellent position to lead efforts to optimize medication therapy through value-based models, and ASHP will be there to make sure that Congress, Medicare and Medicaid, states, and others understand the many advanced practice models our members are engaged in as well as the direct patient care roles they play.

As we continue to work with Congress, states, and public and private payers to recognize pharmacists as patient care providers, we will keep you apprised of these activities and our many advocacy efforts on your behalf — addressing persistent drug shortages, rising drug costs, and threats to the 340B Drug Pricing Program, as a few examples.

Thank you for your support and your continued engagement as we work together to help our patients achieve optimal medication therapy outcomes and to advance pharmacy practice.

Sincerely,

Paul

January 29, 2018

Preserving 340B Is Essential to Our Most Vulnerable Patients

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

ORGANIZATIONS PROVIDING CARE TO MEDICALLY UNDERSERVED rely on the 340B Drug Pricing Program, and ASHP is committed to fighting ongoing threats to the program that could have serious consequences for our patients. ASHP has a long history of support for the 340B program, and many of our members have seen firsthand the benefits of the program to the patients they serve. As Congress considered overhauling the nation’s healthcare system last year, ASHP developed Principles on Healthcare Reform that included our support for the 340B program. We continue to collaborate with numerous stakeholders, including our longstanding partners at the American Hospital Association (AHA) and 340B Health, to prevent cuts to program eligibility and scope.

Last August, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that cuts Medicare Part B reimbursement for drugs purchased through the 340B program from ASP plus 6 percent to ASP minus 22.5 percent. Along with the AHA and many other like-minded stakeholders, ASHP submitted comments to CMS opposing the cuts. In addition to the comments, ASHP lobbied on Capitol Hill to garner signatures to a Dear Colleague Letter from Congress to CMS urging the agency not to go through with the cuts. During ASHP’s annual Legislative Day in September, over 100 ASHP members met with their members of Congress to discuss, among other issues, the importance of the 340B program to their organizations and the critical role it plays in their ability to provide care to the medically underserved.

In November, CMS finalized the rule, and the reimbursement cuts were set to begin this year. AHA has filed a lawsuit challenging CMS’s authority to impose the cuts on the federal 340B program, and ASHP is supportive of AHA’s efforts. We are extremely disappointed that the rule putting the cuts in effect was finalized, and we remain committed to advocating for overturning this rule.

To that end, ASHP supports legislation (H.R. 4392) that would block the CMS-imposed cuts. Sponsored by Representatives David McKinley (R-W.V.) and Mike Thompson (D-Calif.), the bill currently has 181 co-sponsors in the House. In addition to our letter of support, ASHP has created a grassroots letter of support for our members to send using our electronic letter-writing platform.

We know that there will be additional threats to the 340B program in 2018. For example, recently introduced legislation (H.R. 4710) would impose a two-year moratorium on disproportionate share hospitals applying to become covered entities within the federal 340B program. This bill would also require additional reporting requirements, including reporting of the number of insured patients, total cost of charity care provided, reimbursement for all drugs, and a listing of all third-party vendors associated with the 340B program. ASHP has strong concerns over this legislation, and we expressed our opposition in writing to the bill’s sponsors. Similar legislation (S. 2312), was introduced in the Senate, and ASHP will oppose that bill as well.

We expect to see additional legislation later this year. The House Energy and Commerce Committee last week released a report on the 340B Drug Pricing Program. The committee has been examining the structure, operation, and oversight of the program over the past two years through stakeholder meetings, committee hearings, and document collection. Further, Committee Chairman Greg Walden (R-Ore.) has stated that there will be legislative efforts to change the 340B program this year to focus on definition, transparency, and oversight. ASHP developed an issue brief summarizing that report and the potential legislative options that may result.

ASHP remains committed to supporting the 340B Drug Pricing Program, and we will continue to do so through assertive advocacy on Capitol Hill, grassroots advocacy, comments to federal agencies, and meetings with agency officials. Further, ASHP will continue working with other program supporters such as AHA and 340B Health to protect the program from threats, both legislative and regulatory.

Thanks so much for continuing to advocate on behalf of your patients and the profession, and for being a member of ASHP.

Sincerely,

Paul

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