September 2019

by David Benoit

Tomorrow will just happen or you can plan to make it better than today.

DIR fees are bad for business, we need a different model. We see zero rebate dollars, yet five brand manufacturers averaged net prices of 50% of list price. We can buy for about 20% off list, which means that about 30% of list is pure profit for the PBMs and the plans. That’s in addition to the DIR fees. Our margins have been pressured to a point that profit is only a dream. That’s today.

To survive in the current marketplace, we have to work fast and efficiently while maintaining 100% accuracy. The pace of the work means we don’t have time for patients. And patients do need the help to take their meds properly, to be adherent, to manage adverse events, and to achieve their desired therapeutic and clinical goals. Plans need patients to have all of these positive outcomes in order to have high quality ratings. So, they are beginning to pay others, like case workers and quality assurance personnel to increase their quality scores. The plans have money to spend, not on drugs but on care. To succeed tomorrow, we have to learn to speak their language.

If you have only a vague idea about how CPESN can help you (Community Pharmacy Enhanced Services Network) there is a great opportunity to learn. (To join CPESN visit For more information contact The NCPA Convention will have lots of programming that will help you appreciate CPESN quickly. There will even be an information session hosted by the New England CPESN chapters on Monday, October 28, in the hotel at noon. The NCPA Annual Convention is in San Diego, CA from Saturday October 26 until Wednesday October 30 th. If you haven’t been to San Diego, it is one of the nicer places in the USA to visit. The convention center is situated in the Gaslamp District with many fine hotels and restaurants. You can walk to the Padres ballpark. The airport is only about three miles from the meeting. Click the button at the end of the article to register.

Over the summer, CPESN worked with the Community Pharmacy Foundation to award grants for CPESN state chapters that wanted to transform willing businesses from the current transaction-based operation to the pay for services patient-focused practice. This program is called Flip the Pharmacy. NPSC worked with the four local chapters to submit an application by the August 12 deadline. We were not one of the successful applicants this round, but we all plan to resubmit next year.

The tools for documenting care for patients are here. The companies that have eCare plans are working diligently to make them more robust and user friendly. Pharmacies using eCare plans have found that they are a great communication mechanism for all members of the pharmacy’s team to know exactly where the patient stands on the care continuum. All 49 Medicaid programs have CDC grant money to help educate and mange diabetic patients. State associations are getting involved. Health plans wishing to improve their quality scores need the kind of help that we used to and can very effectively provide again. Software vendors are making enormous commitments in support of eCare plan activities.

You go to work each day and get caught up in the grind. It is often impossible to look past the pharmacy counter, where you must perform now. At the same time, you need to get your business ready for tomorrow. Take some time to invest in your business and relax at the same time. Join us in San Diego. We would love to see you there. We wouldn’t miss it. And you shouldn't either.
Spectrum Responds to Warning Letter Issued
In a letter issued June 12, 2019 Spectrum Laboratory Products confirmed receipt of a Warning Letter issued by the Division of Pharmaceutical Quality Operations IV of the FDA following an inspection. In the letter Spectrum states, "Spectrum recognizes the concerns presented. Spectrum is working diligently and closely with the FDA in formulating a response to the agency in addressing these concerns as quickly as possible."
Sanofi Pasteur anticipates that the delivery of influenza vaccines from VaxServe and FFF will be approximately 3-4 weeks delayed. Sanofi will deliver all doses to cover all open orders, but the timing will be pushed back as mentioned in the attached customer letter. Please take this into consideration when planning your flu clinics. Click below for the full customer letter for further details.
ATTN CT: Plastic bag fee. Beginning on August 1, 2019, retailers are required to charge 10¢ for each single-use plastic bag provided at checkout. These plastic bags will be banned on June 30, 2021.
Pharmacy-Based Immunization Delivery 2019
October 10, 2019
University of Rhode Island
Hilton Providence
21 Atwells Ave.
Providence, RI 02903
Care Credit : Another Payment Option for Your Customers
Care Credit is a payment service that offers your customers another way to pay for deductibles, co-pays and out-of-pocket expenses. As a provider, you are listed on their website so that customers can easily search and find you. Payments to you arrive in as little as 2 business days. Click below to see if becoming a Care Credit provider is right for you.
Welcome to NPSC
Colonial Village, Contoocook, NH
Goldenseal Apothecary, North Andover, MA
Health First Pharmacy, Framingham, MA
Manchester Pharmacy, Manchester, CT
Northfield Pharmacy, Northfield, VT
Westown Pharmacy, Manchester, CT
Helping Your Patients With Medicare Plans
By Pat Monaco
Amplicare (formerly known as iMedicare) published an article earlier this month “What Pharmacists Should Know Before 2020 Medicare Plan Enrollment”. The following are the main points:

  • There are 59 million beneficiaries today – there are 10,000 more per day going forward
  • Most need help understanding their plan options – Are you able to offer that help?
  • If you can, without telling them what plan to sign onto (which is prohibited) help them compare plans in their best interest. Most don’t feel confident to make changes so they stay with their current plan which may not be in their best interest – or yours!
  • What was “good in 2019” may not be good in 2020 so there is great benefit in comparing.
  • Helping your patients understand what is in their best interest builds your relationship with your patients, may increase retention and drive growth. Comparisons also allow you to evaluate which plans are hurting your business.
  • Do you know who your Medicare patients are today and who is joining in 2020? Amplicare and other services like them have the ability to give you this information. This allows you to target communication to your two patient groups and provide customized handouts on co-pays, premium costs, total out of pocket costs etc. Newly eligible patients would really appreciate hearing from you to offer a free plan comparison.
  • There are changes to Medicare Plans in 2020 – It will be important to know what the changes are so you can help your patients:
  • Newly eligible Medicare patients will no longer be able to purchase Medigap plans that cover Part B deductible (plans C and F).
  • Elimination of the donut hole for generic drugs. Enrollees in standard Part D plans will instead pay 25% of the cost of their drugs up to the catastrophic coverage threshold.
  • CMS is adding flexibility to Medicare Advantage plans with more options and new benefits
2019 Med D Compliance Attestation
Express Scripts requires its network Providers to conduct CMS General Compliance and Fraud Waste and Abuse (FWA) training within 90 days of initial hire and annually thereafter. 

Providers can complete the CMS General Compliance and FWA Training utilizing the training provided by CMS at the following link: .

ESI also mandates pharmacies to annually attest that they have met this training requirement. The National Council for Prescription Drug Programs (NCPDP), through the collaboration of the pharmacy, Part D sponsor and PBM community, has developed a solution that will allow pharmacies to complete a standardized Med D Attestation online through the NCPDP website. NCPDP will then send the pharmacy’s Med D Attestation to the Part D sponsors and PBMs who subscribe to NCPDP.

If you have not yet completed the standardized 2019 Med D Attestation available on the NCPDP website, simply login to your pharmacy NCPDP profile at: .

If your pharmacy needs NCPDP login information, please email NCPDP at  and include the pharmacy name and NCPDP number. Please note you cannot reset your passwords by calling NCPDP directly. 
The deadline for completion of your annual attestation is December 31, 2019.
If you need a member’s specific prescription processing information or other help with a claim, please visit our Pharmacist Resource Center at .

Argosy Group offers the NPSC network FREE monthly webinars with the best in DME information! It will be the best 30 minutes you spend all day!
Next Webinar
Date: October 8 Time: 11:00 EST
Topic: Outsourcing:
 Deciding When It Is Appropriate

NPSC pharmacies who are either an owner, manager, or staff pharmacist receive $100 off registration rates with promo code BUY100. No expiration.  Register early to take advantage of early bird rates!
2019 Legislative Victories in New England
by Ron Lanton, NPSC Lobbyist
Medicaid Managed Care Reform
Massachusetts H 4000 now requires the Secretary of Health and Human Services to investigate and develop a report for increasing transparency on PBM services in the Medicaid program. Click here to learn about the new law

PBM Audits:
Rhode Island HB 5544/SB 581
Rhode Island enacted a new pharmacy law that provides much needed fairness for when pharmacies are engaged in a PBM audit.

Connecticut HB 7363
The legislation places major restrictions on pharmacy benefit manager (PBM) clawbacks, or the results of an insurance company assigning expensive copays to a drug leading to a significantly higher price than the value of that drug, along with direct and indirect remuneration (DIR) fees. Furthermore, it prohibits PBMs and insurance companies from forcing pharmacies to pay back any part of a claim that the PBM or insurance company has already paid.

PBM Transparency:
New Hampshire SB 226 was enacted regarding much needed PBM transparency. This new law prohibits retroactive claim adjustments; strengthens existing MAC transparency laws and re-establishes a commission to study the role PBMs play in the cost of prescription drugs.
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Lauren Fletcher 423-643-0821
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Northeast Pharmacy Service Corporation
Northeast Pharmacy Service Corporation
(508) 875-1866
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