LTC Pharmacy News

September 2023

Dear Pharmacists and Pharmacy Owners, We hope this email finds you thriving in your invaluable work as healthcare providers. I am excited to curate a newsletter specifically for pharmacists and pharmacy owners like you.

Long-time readers will note the change in the format of LTC Pharmacy News. The letter has had the same format for more than eight years and I have been thinking it may be time for a change, not just to the format but some of the content.

For example, we have rarely reported on developments in the states but, since states are taking the lead on more innovation, I think we might want to add more coverage.

We have reported on industry news, as well as marketing and business development. That will continue, but I would also like to experiment with adding some tutorials for those who may be new to LTC pharmacy. So, look for that to come along soon.

Lots of other ideas in the works which will be covered in upcoming newsletters. Meanwhile, I hope you like the new format. Let me know

Warm regards,

Paul Baldwin

paul@ltcpharmacy.net

Federal News and Updates

HHS Announces List of Drugs Subject to Medicare Price Negotiations

Dept. of Health and Human Services revealed the list of 10 drugs that will be the first medicines subject to price negotiation with manufacturers. the Department notes that these 10 drugs account for more than $50 billion in annual sales, and expects the negotiation process, when completed, to yield $25 billion per year in cost savings.

HHS Fact Sheet

More on Drug Price Negotiation

As with any government program, there are unanticipated consequences. ASCP has warned that there is a potential for adverse consequences for LTC pharmacies as a result of the outcome of these negotiations.

CMS Finally Reveals Nursing Home Staffing Mandate

Long expected and finally here, CMS has published a proposed rule mandating staffing levels in nursing homes. The agency is proposing a minimum of three hours of direct care per day, a minimum of 55 minutes of care by a registered nurse and the remainder by a nurses aid. The proposal envisions giving urban nursing homes three years to come into compliance. Hardship exemptions are available.

Industry response was chilly, with major trade associations arguing that these goals are unachievable, given that there are simply not enough staff available to fill these roles.

Labor Dept. Issues Proposed Rule on Overtime Pay

We don't normally cover the comings and goings of the Dept. of Labor, but this development is certainly worth mentioning. The Dept. has issued a proposed rule that would require the payment of overtime for salaried workers earning less than $55,000 per year, in increase from the current top level of $35,000. In addition, the $55,000 ceiling would be automatically adjusted every three years.

Dept. of Labor News Release

Proposed Rule

The Senior Care industry reacts

FDA Approves Two COVID Vaccines for Fall

Just in time for the fall, FDA approved two COVID vaccines, from Pfizer and Moderna. These vaccines are monovalent, targeting the Omicron variant XBB.1.5. Bivalent vaccines are no longer approved.

The Center for Disease Control has recommended these vaccines for all persons 6 months of age and older.

Healthcare Finance

House to Vote on PBM Bill

The House Energy and Commerce (E&C) Committee Chairwoman has introduced the Lower Cost, More Transparency Act which is an amalgam of legislation previously approved by House committees and which aims to throttle some of the abuses seen in the PBM industry.

The House of Representatives may vote on this legislation the week of September 18.

Fierce Healthcare

GAO Finds Medicare PBMs May Pay Less for Some Drugs Than Beneficiaries Pay in Cost Sharing

The Government Accountability Office released a report demonstrating that for 79 of the top 100 Medicare Part D drugs, plan sponsors paid less, after rebates than beneficiaries paid in cost sharing.

GAO recommended that CMS monitor the effect of rebates on formulary design and ensure that certain Medicare beneficiaries are not discouraged enrollment. CMS did not agree.

GAO

News From the States

New York Proposes Tough Regulations on PBMs

The New York State Department of Financial Services released a proposed rule that would restrict PBMs from clawing back payments to pharmacies. The proposal would also prohibit PBMs from imposing several types of fees on network pharmacies and prohibit gag clauses.

Written comments on the proposed rule are due by October 16.

Pharmacy Wins Settlement in Washington State

The Washington Pharmacists Association, NCPA, and NACDS announced a settlement with Washington Medicaid over the agency's failure to establish Medicaid cost-based dispensing fees. The settlement also requires $60 million in retroactive pharmacy payments and an interim cost-based dispensing fee from July 1 going forward.

NACDS

Everything Else

Health IT Venture Capital going to AI and Remote Patient Monitoring

You saw this coming. The world is going bonkers for Artificial Intelligence and the " smart" money is supporting it with money. What you may not have guessed is that venture capital companies are also very interested in remote patient monitoring. Even if you don't follow venture capital, you will find this article interesting.

Med City News

Elon Musk: The Book

Walter Isaacson's biography of Elon Musk is out.. If you're not quite ready for the entire 688 pages yet, you might find this summary of the more interesting parts worth reading.

That's it for this edition. I will be staying busy putting together the next issue, so stay with me. My intention is to make LTC Pharmacy News the email you look forward to receiving. I am grateful for so many of you who have been with me for the duration. I will do my best to earn your continued loyalty.