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"To Preserve, Protect and Promote

the Interests of Pharmacy Owners."

April 2019
In This Issue
Summer 2019
PFOA staff strives to meet with as many of our members as possible through trade show attendance. If you plan to attend any of these shows, please tell your sales consultant.

Independent Pharmacy Conference
sponsored by IPC
San Antonio, TX
May 2-5, 2019
This conference is open to all independent pharmacies, regardless of primary wholesaler

American Pharmacies
APEX 2019
San Antonio, TX
June 13-15, 2019

McKesson IdeaShare
Orlando, FL
June 26-30,2019

Cardinal Health
Retail Business Conference
Nashville, TN
July 17-20,2019
PFOA Annual Meeting Part 1

Las Vegas, NV
July 24-27, 2019
PFOA Annual Meeting Part 2
Welcome New
PFOA Members
Bridgeport Family Pharmacy
Bridgeport, WV
Slippery Rock Pharmacy
Slippery Rock, PA
 DEA to Hold Next Prescription Drug Take-Back Day April 27, 2019

Drug Enforcement Administration (DEA) has announced another opportunity for consumers to dispose of unneeded and expired prescription drugs during the next DEA National Prescription Drug Take-Back Day on April 27, 2019. On this day, thousands of collection sites will be available across the country to accept unneeded prescription drugs, including controlled substances, for safe and legal disposal. Since 2010, DEA has held 16 National Take-Back Days, and has collected and disposed of a total of 5,439.5 tons (nearly 11 million pounds) of these medications.
From NABP e-News (edited)
 Collins Says, "the tide has turned" in Battle Against PBMs
Six years ago, when Rep. Doug Collins (R-Ga.) began advocating for community pharmacy, he says that the PBMs "laughed at me." However, Collins, also speaking at the 2019 NCPA Congressional Pharmacy Fly-in, said, "I think the tide has turned." Noting that bigwigs from the PBMs were grilled in a Senate hearing on Tuesday, Collins said, "That was kind of fun to watch." Collins also pointed out that PBMs now seem compelled to spend money to boost their PR, "but can't explain away DIR fees that average $82,000 per pharmacy practice." Collins, among community pharmacy's biggest champions, said that "as long as I'm here, I will always have your back."
 DEA Warns of Increase in Scam Calls Targeting Pharmacists
Health care providers and other members of the public have reported receiving phone calls from people claiming to represent DEA, and threatening legal action against them if a large fine is not paid immediately over the phone. According to a DEA press release, this scam used fake names and badge numbers, or the names of well-known senior officials with DEA, and threatened victims with arrest, prosecution, imprisonment, and revocation of their DEA numbers. The agency emphasizes that DEA will never contact practitioners by phone to demand money or any form of payment. DEA will not request any personal or sensitive information by phone, and notification of legitimate investigation or legal action is made via official letter or in person.
DEA asks anyone who receives a call from a person purporting to be a DEA special agent or other law enforcement official asking for money to refuse the demand and report the threat using the online form or by calling 877/792-2873. Reporting these calls will assist DEA in investigating and stopping this activity.
From nabp e-news
 First Generic Naloxone Nasal Spray Approved by FDA
On April 19, 2019, FDA granted final approval of the first generic naloxone hydrochloride nasal spray to Teva Pharmaceuticals. The newly approved medication is the first generic version of naloxone, the medication used to reverse the effects of an opioid overdose, intended to be administered by individuals without medical training. The spray does not require assembly and delivers a consistent, measured dose when used as directed, and can be used for adults or children. In a press release announcing the approval, FDA also outlined other actions it is taking involving naloxone, including action to help facilitate an over-the-counter product, previously announced in January.
From nabp e-news (edited)
 PFOA Welcomes New Staffer
Our newest PFOA staffer is April Adkin who joined the association earlier this month. 

April has been training and shows great promise in her capacity of Administrative Assistant in our Coral Springs office.

We welcome April to the team and look forward to her contributions to PFOA.
PFOA logo
Board of Directors
Todd Pendergraft

Vice President:
 Doug Coyle
    Larry McIntosh

Phil Rigsby

  Board Members: 

Gabriel Guijarro

 Eric Pusey

  Ron Robichaux

Ty Stout
John Zuzack

Non-Voting Board Members:

Dirk Andrepont

Gaye Moseman

Board of Directors
Dirk Andrepont
John Zuzack
David Cole

Phil Rigsby
Board of Directors

Eric Pusey
Bobbie Barbrey

PFOA Staff
Contact Information 
David Mayper
Executive Director
Nancy Coibion
Administrative Assistant
Mailing Address
  10944-B Gravois Industrial Court 
  St. Louis, MO 63128
April Adkin
Administrative Assistant
954-340-5944 x138

Wesley Behar
West Region Sales

Ronda Hubbard  
Generics Specialist/Sales
Fax: 270-632-4206

Patrick Kittoe
Southeast Sales
Al Schuster
Northeast Sales
Bob Sutton
Vendor Programs/Mid-West Sales
Nancy Tataronis
Vendor Relations/Marketing
  Jamie Wilbanks
Inside Sales/Service
Toll Free: 888-406-7467

Get Linked In!  

Pharmacy Franchisees and Owners Assn
(FPN) Federation of Pharmacy Networks
       (NCPDP) National Council for Prescription Drug Programs  
        (NCPA)  National Community Pharmacists Association 

(NABP) National Association of
Boards of Pharmacy

(NASPA) National Alliance of State Pharmacy Associations

  Pharmacist E-Link   

Dave Mayper
We had a busy month at PFOA with staff transition and training. I am working diligently to make sure this goes smoothly and we are prepared for additional changes. We have effectively transitioned rebate operations for conveying of rebates on all major rebate payments. We are working on benefits for the staff and of course going about the business of serving our members' needs. We also attended major events for PFOA and our industry over the last few weeks.
In April we hired April Adkin as our administrative assistant in Coral Springs. She is progressing on all fronts and has shown the ability to extend past the probationary period. She can be counted on as a valuable member of the team. This presently leaves Nancy Coibion in St. Louis through her planned retirement June. Jamie continues to help us administratively as well as in her role of inside sales.
Patrick Kittoe has completed visitation of his territory from Florida to North Carolina for existing members. Patrick has effectively taken over areas that Wes Drake Jr, Wes Drake III and I had been covering. He has already received high marks from members he has visited and will be a valuable contributor to PFOA.
Our splitting of the National Director's responsibilities continues to work well with both Wes Behar and Al Schuster sharing these duties.
For the month of May, we are planning a webcast sponsored by Spectrum, our approved vendor for compounding supplies and education. This webcast will include a giveaway drawing for one participating member.
We should have ready shortly the password protected back end member portion of the PFOA website that will allow members to review their rebates and other proprietary information.
This month three PFOA staffers attended and participated in the AAP annual meeting. They returned with valuable information and had some good interaction with attendees. We sponsored a hospitality suite as we have done in years past. This suite also served as a good meeting room for our staff to work with members and other meeting participants on a scheduled basis during business hours. Business reviews were performed and the staff reported a number of our members and vendors joined us after hours at the suite giving us the ability to get to know them better and to network. This is always a well-attended event for our members and brings great information. In addition to the AAP annual meeting, Ronda Hubbard attended the NCPA Fly-In on PFOA's behalf. The meeting of government affairs was sponsored by NCPA and held in Washington DC.
I was watching NBC Nightly News last night and it led off with a story on the Opioid Crisis. It showed the former CEO of Rochester Drug Cooperative (RDC) being led away in handcuffs for the role he played as a distributor contributing to the Opioid Crisis featuring a major increase on supply and an under reporting of suspicious quantities. I expect this will have a ripple effect throughout the industry. When I came to PFOA it was quickly realized that the Opioid Crisis was going to affect how we all do business. Efforts to curtail the issue will continue to do such.
I thank you for continuing to allow me to be your Executive Director.  
Yours Truly,
David Mayper
Azar Brings Down the House with Pledge to Fight for Community Pharmacy

The 2019 NCPA Congressional Pharmacy Fly-in kicked off with a bang,  including an address by Health and Human Services Secretary Alex Azar , who brought community pharmacists to their feet with his pledge to take on the big special interests who manipulate the prescription drug marketplace at the expense of independent pharmacists and their patients.
Saying he personally has "already come to understand how valuable a role" community pharmacists play, Azar laid out the administration's four-part strategy for reducing prescription drug prices: boosting competition, improving negotiation, creating incentives for lower list prices, and lowering out-of-pocket costs. Central to that strategy, Azar explained, are three initiatives on which NCPA has worked closely with his department. The first was ending so-called gag clauses, one of Azar's first actions as secretary and the focus of legislation later passed by Congress and signed by the president.
The second initiative is a forthcoming rule to fix pharmacy DIR fees, which he teased in his speech and which could come out any day. NCPA has led the charge to fix DIR, starting in 2014. NCPA CEO Douglas Hoey, Advocacy Center Director Karry La Violette, and her team have met often with Azar and his deputies in the last year to discuss how PBMs are using these fees to fleece patients, taxpayers, and pharmacists.
Finally, Azar cited the new rebate proposed rule which aims straight at the "backdoor" system of rebates between pharmaceutical manufacturers and PBMs.
"What was created as a protection for arrangements that serve patients and taxpayers has become, we believe, a major driver of the ever-increasing list prices that burden far too many American patients at the pharmacy counter," said Azar. "Anyone who stands for rebates, stands for ever-higher list prices, and against transparency and lower patient out-of-pocket costs at the pharmacy. It's that simple."
Azar's remarks were met with an extended ovation, after which NCPA members headed off to Capitol Hill to meet their lawmakers armed with lots of enthusiasm and a powerful ally in the administration.
Ronda Reports

PFOA was represented at the NCPA Congressional Fly-In April 10-11, 2019 in Washington, D.C. by staffer, Ronda Hubbard.
The theme for this year's meeting:  Pro-Patient, Pro-Pharmacist and the group concentrated on the following issues:
Improving Transparency and Accuracy in Medicare Part D Spending Act (S. 988/H.R. 803) - DIR Fees  Prescription Drug Price Transparency Act (H.R. 1035) - Medicare transparency provisions concerning MAC for generics, also establish a MAC appeals process & prohibit PBM requirements to use a PBM-owned pharmacy
Preserving Patient Access to Compounded Medications Act (H.R 1959) - preserves patient access to compounded meds by directing the FDA to act within Congressional intent
Open Medicare Part D Preferred Networks to Any Willing Pharmacy - give seniors more access to discounted copays and their pharmacy of choice (the first one failed - but it was cosponsored legislation when first introduced)
Join the Congressional Pharmacy Caucus - educates Members of Congress and staff about issues affecting community pharmacies and patient access to prescription drugs and pharmacy services.  (Rep. Peter Welch-D. VT & Buddy Carter-R, GA are spearheading this initiative)
Ronda was unable to speak directly to any members of the House or Senate but did speak with their assistants including: Rep. Blaine Luetkemeyer-MO, Senators Rand Paul & Mitch McConnell-KY, Rep. James Comer, KY, Rep. Lucy McBath, GA, Rep. Brian Mast, FL, Rep. Ralph Abraham, LA, Rep. Rob Woodall, GA, Sen. Thom Tillis, NC, Sen. Rob Portman, OH, Sen. Tina Smith, MN.
Ronda distributed information on DIRs which was supplied by a PFOA member. We all look forward to a resolution on the final rule on this issue soon.
This meeting once again proved to be a valuable tool for collecting legislative information for our membership .
AAP Annual Conference Report
Co- Sales Directors Al Schuster and Wesley Behar, along with Southeast Sales Representative Patrick Kittoe attended this year's AAP Annual Conference in Sa Antonio. According to AAP management, there were about 1000 attendees including 63 PFOA members representing 33 PFOA member stores.
The staff visited the trade show floor, concentrating on 15 vendors who are approved PFOA vendors.

The three attended the AAP Welcome Session, then worked crowd to meet members and mingle with non-members. When the exhibit hall opened, they continued to mingle, meeting with AAP management and sales reps, and many PFOA approved vendors.
When the reception ended, the staff moved to the hospitality suite and entertained the PFOA members and vendors who stopped by. Members included : Eric and Sherry Belldina, Dirk and Elizabeth Andrepont, Doug Coyle, Paul and Rebecca Reed, David Cyr, Toni Barbuto and Anita Bogusweski
The group attended the Keynote Address called What High Performers do Differently and CEs titled Leveraging Pharmacy Data to Improve Profit, Pharmacists' Roles and Op
portunities within the Immunization Neighborhood and Preparing for a DEA Inspection. While attending the Rx30 Users meeting, they learned about new features the latest updates and upcoming enhancements.
Business reviews were conducted with several PFOA members and conversations took place regarding store acquisitions, store layout and other pertinent information. They also met with stores interested in learning more about PFOA and will follow up with those owners after the show.
As usual, AAP put on a conference filled with valuable content and it was well attended. Our three PFOA staffers felt their attendance was worthwhile and look forward to next year's conference.
AmerisourceBergen Supports Transitioning Pharmaceutical Rebates to POS Discounts

AmerisourceBergen, alongside its industry trade association, the Healthcare Distribution Alliance, announced that it has proposed a comprehensive framework that would support the proposed move from the current rebate system to point-of-sale discounts in response to the Department of Health and Human Services' Notice of Proposed Rule Making regarding the Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals.
AmerisourceBergen said it supports policies that lower out-of-pocket costs for patients and stands ready to support a transition to a patient-centered model with distributors serving as chargeback administrators for a Jan. 1, 2020 start.
"At AmerisourceBergen, we are acutely aware of the access issues facing American patients and are deeply committed to reforms that realign incentives in the best interests of patient health," AmerisourceBergen chairman, president and CEO Steve Collis said. "As the connector of pharmaceutical innovators and healthcare providers, distributors are uniquely positioned to support the seamless and efficient delivery of POS discounts to Medicare beneficiaries. We come prepared with solutions that are fair, efficient and transparent, and that's why we believe we are best positioned to lead this transition."
In support of a distributor-facilitated model, AmerisourceBergen outlined the following:
  • "Pharmaceutical distributors have strong service-oriented relationships, built on fairness and trust, with their pharmacy customers and manufacturer partners. These longstanding relationships allow distributors to approach this reform in a fair and equitable way to meet the needs of all stakeholders, and most importantly, create a positive impact for patients. Further, pharmacies are important customers for wholesalers, so it is in distributors' best interest to ensure that pharmacies promptly receive POS discounts. In addition, distributors have no role in setting the price of brand pharmaceuticals and do not influence formulary decision-making;" 
  • "Distributors and manufacturers already have the requisite building blocks in place to operationalize chargeback amounts due for discounts applied at the point of sale. Distributors and manufacturers manage and maintain complex contract administration and chargeback systems today that enable manufacturer discounts for health system customers. In 2018 alone, AmerisourceBergen exchanged over 300 million chargeback transactions with manufacturers with greater than 99% successfully completed in three business days or less. Extending this proven chargeback system to handle POS discounts would be a natural evolution;"
  • "Chargebacks would be processed with full visibility and audibility by all stakeholders. Further, given the existing direct financial relationships with both manufacturers and providers, distributors could facilitate chargebacks through adjustments to their accounts payable to manufacturers and accounts receivable from pharmacies, resulting in cashless transactions;"
  • "To further operationalize, pharmaceutical distributors would, directly or indirectly from their customers, secure the requisite chargeback detail from the POS claims and provide an efficient and effective process for manufacturers to make pharmacies whole, meeting or exceeding the mandatory 14-day prompt pay requirement."
Collis said, "We are ready to play a role, and hope our suppliers, dispensing partners and industry peers will join us in pursuing a distributor-facilitated model that would no doubt improve transparency and deliver more value directly to patients."

By Sandra Levy, Published in Drug Store News
NCPA Awaits Forthcoming DIR 
Drug Pricing Rule

Community pharmacists are eagerly awaiting release of a drug pricing rule. If the rule is finalized as proposed, it would move pharmacy price concessions to point-of-sale, eliminating the retroactive nature of pharmacy direct and indirect remuneration, or DIR, fees the National Community Pharmacists Association said.
"The current pharmacy DIR system isn't transparent, isn't efficient, and isn't fair to patients or pharmacies," NCPA CEO Doug Hoey said. "It's a one-sided system that leaves other parties at the mercy of PBMs and plans. NCPA wholeheartedly supports moving pharmacy price concessions to point-of-sale, or ideally, eliminating pharmacy DIR altogether. We also support development of a standard set of pharmacy quality measures that truly measure better health outcomes for our patients."
Pharmacy DIR fees are imposed by plan sponsors and associated pharmacy benefit managers on pharmacies participating in Medicare Part D networks, and NCPA said they currently are being misused to extract reimbursements from pharmacies well after a transaction, Further, NCPA said the fees often are unpredictable and seemingly unconnected to a pharmacy's performance related to adherence and other standards. This makes it difficult for community pharmacies to operate their business and also means beneficiaries face higher cost-sharing for drugs and are accelerated into the coverage gap or "donut hole" phase of their benefit.
"We've experienced a skyrocketing increase in the amount of pharmacy DIR, which grew an eye-popping 45,000 percent between 2010 and 2017," Hoey said. "We're hopeful that the new rule fixes the inappropriate way pharmacy DIR has been abused."
By Sandra Levy, Published in Drug Store News (edited)
New Insulin Price Won't Top $25. per Month Out-of-Pocket, Cigna says
Health insurer Cigna is launching a program that will cap out-of-pocket expenses at $25 for a 30-day supply of insulin, the company saidearlier this month. Last year, patients paid an average of $41.50 a month out of pocket, including deductibles, copays or coinsurance, for the lifesaving diabetes drug, the company said.
The Patient Assurance Program will be available to members of participating non-government-funded pharmacy plans managed by Express Scripts, including Cigna and other plans. Cigna acquired Express Scripts, the largest US pharmacy benefit management company, in December.
"In most cases, people who use insulin will see lower out-of-pocket costs without any increased cost to the plan," the company said.
The move follows the US Food and Drug Administration's announcement that it intends to bring competition to the insulin market as a way to lower prices. Commissioner Dr. Scott Gottlieb said the FDA would change how insulin is regulated in order to enable products that are biosimilar to (or interchangeable with) insulin to come to market.
Biologics are typically isolated from a natural source and may be produced through biotechnology and other cutting-edge technologies, Gottlieb explained: "Once an interchangeable insulin product is approved and available on the market, it can then be
substituted for the reference product at the pharmacy, potentially leading to increased access and lower costs for patients."
Insulin pricing in the United States is driven by a supply chain consisting of manufacturers, wholesalers, pharmacy benefit
managers, insurers and pharmacies, according to the American Diabetes Association: "In much of Europe, insulin costs about a sixth of what it does in the United States."
At a US House of Representatives subcommittee hearing on insulin pricing Aaron Kowalski, chief mission officer of JDRF, a nonprofit diabetes research funding organization, called for the elimination of rebates -- which make up more than 70% of the list price of insulin -- from the drug reimbursement system.
"In the current system, companies give discounts to pharmacy benefit managers and health plans while increasing prices at the pharmacy counter," he said. He also believes that manufacturers need to lower list prices and restrict increases to "no more than the consumer price index."
"If this occurs, we believe that strong competition among insulin manufacturers will quickly push them to lower prices to net levels, which will greatly benefit patients who need this drug to survive," Kowalski said.
By Susan Scutti, CNN (edited)