Policy Priorities

Preserving, protecting and defending the health and safety interests of our increasingly diverse patient population — and bolstering the economic viability of independent LTC pharmacies serving their growing needs — are the foundational pillars of SCPC’s federal legislative and regulatory agenda. Moreover, fostering a strong and dynamic independent LTC pharmacy sector is integral to improving patient outcomes and optimizing Medicare savings, today and in the future. Operating in today’s volatile, unpredictable legislative and regulatory environment requires flexibility, foresight and tactical agility. These four overarching principles will guide us:

  • Clinical efficacy, and achieving optimal patient outcomes
  • Pricing transparency and marketplace equity
  • Regulatory efficiency, effectiveness and fairness
  • Policy solutions that anticipate and act upon future trends related to our long term and post-acute care patient populations
Pharmacy Benefit Managers (PBMs): Unaccountable Drug Industry Middlemen
Pharmacy Benefit Managers (PBMs) serve as administrators of prescription drug plans (PDPs) and are responsible for developing and maintaining clinically appropriate drug formularies, negotiating contracts with pharmaceutical manufacturers, wholesalers and pharmacies.

PBMs process prescription drug claims for PDPs, including Medicare and Medicaid plans, employer- sponsored plans, and plans in the individual market. PBMs typically generate income from drug manufacturers through complex payment mechanisms – generally known as “rebates.” PBMs also extract various administrative fees and charges from pharmacies, which generally are buried in lengthy contractual language.

In some cases, these contracts actually prevent the pharmacy or pharmacist from informing consumers that it would be less expensive to pay for a prescription entirely out-of-pocket instead of going through the PBM and paying a co-pay or deductible.

In most Long-Term Care Pharmacy (LTCP) agreements, pharmacies must pay a fee per prescription. LTCPs appear to be the only providers of any type ultimately paid by Medicare or Medicaid which must pay a fee to third party intermediaries simply to get paid. This is but one example of rapacious post point-of-sale fees and claw backs PBMs impose on LTCPs.

With greater demand from consumers, Congress and regulators about the need for more competition and pricing transparency in our increasingly complex, tumultuous pharmaceutical marketplace, PBMs are increasingly viewed as unaccountable, opaque middlemen.

The time has come for a thorough congressional investigation into PBM pricing and other predatory practices, particularly as they impact LTCPs and their patients. SCPC seeks to work with lawmakers on a constructive, bipartisan basis to bring about more transparency and restrict anti-competitive behavior by the de facto oligopolies that have come to dominate the LTC pharmacy sector, as well as the entire pharmaceutical marketplace.


PBM Legislation:


Fix FDA Repackaging Draft Guidance
Current FDA guidelines – developed without necessary LTC Pharmacy community input – would prohibit essential patient safety care practices. Unless proactively addressed, the draft guidance would: Limit the ability of LTC Pharmacies to prepackage pharmaceutical products – including drugs that remain in the pharmacy – without receipt of a patient-specific prescription/chart order; Prevent any dispatch of prepackaged/repackaged pharmaceuticals, packaged and sent from the pharmacy, in advance of receiving patient-specific prescriptions or chart orders; Impede pharmacy practices in a manner that would negatively impact nursing home compliance with safety requirements.

The FDA currently permits LTC pharmacy repackaging practices in compliance with state pharmacy law. To allow LTC pharmacies to continue meeting the needs of nursing home residents in a timely manner, SCPC believes the Draft Guidance must be revised before it becomes final to continue FDA’s practice of allowing current LTC pharmacy-repackaging practices that meet state law requirements.


Click here to see all news related to the FDA repackaging draft guidance.

Medicare Part D Lock-In
In an effort to reduce substance abuse among Medicare Part D beneficiaries, Congress is considering several proposals to allow Prescription Drug Plans (PDPs) to require Medicare beneficiaries who are prescribed drugs designated as “frequently-abused” to obtain some or all of their prescription medications from one or a very limited network of pharmacies. One proposal also locks these beneficiaries into one prescribing physician for at least some of their medications.We strongly support the laudable goal of reducing substance abuse. However, SCPC believes that applying the “lock in” provision to Part D beneficiaries who reside in long-term care (LTC) facilities is unnecessary, and could threaten these patients’ access to needed medications.


Click here to see all news related to the Medicare Part D lock-in provision.

Maximum Allowable Cost (MAC) Pricing
Independent LTC pharmacies and patients under their care require adequate protection against Medicare Part D pricing policies and other questionable practices that are secretive, opaque, and afford no recourse to address behaviors that inappropriately shift Medicare dollars from providers to intermediaries – like Pharmacy Benefit Managers (PBMs) — in ways that undermine their ability to provide the key consultative services Medicare rules demand.

SCPC believes new research from Avalere Health clearly demonstrates that PBMs’ MAC pricing methodology for generic drugs leads to arbitrary and capricious reimbursement, warranting greater congressional scrutiny.

These PBM pricing policies and practices threaten quality patient care and negatively affect taxpayers, as they eventually add unnecessary costs to the Medicare program. Ultimately, SCPC believes MAC pricing is not market pricing and contrary to the fundamental principles of Medicare Part D. We will build on the progress we made in 2015 focusing public attention on this issue, and move aggressively in 2016 to sustain our case in the public policy arena.


Click here to see all news related to Maximum Allowable Cost (MAC) pricing.

Drug Enforcement Agency (DEA) Relationships
Curbing the potential abuse of controlled substances along with their proper disposal in an environmentally appropriate manner has and always will be a priority of the LTC pharmacy community. SCPC seeks to work with the DEA, CMS and Congress in a collaborative, positive manner to strike the right balance between meeting the stringent enforcement needs that protect our citizens and communities on the one hand, and protecting the needs and care of patients, on the other.

Click here to see all news related to Drug Enforcement Agency (DEA) Relationships.

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