In direct response to extensive IPA advocacy efforts in collaboration with Senator Chuck Grassley [R-IA], CMS issued a public memo to Part D sponsors and their PBMs, acknowledging pharmacies' concerns ahead of the 2024 DIR cliff. In the memo titled, “Application of Pharmacy Price Concessions to the Negotiated Price at the Point of Sale Beginning January 1, 2024,” the agency commits to adopt some proposed solutions, including increased monitoring and enforcement of CMS regulations requiring ‘reasonable and relevant' contract terms, access standards, and prompt payment. CMS also strongly encourages Part D plan sponsors to provide payment plans or alternate payment arrangements to pharmacies ahead of Q1 of 2024. 

During a Senate Finance Committee hearing the following day, Senator Chuck Grassley spoke on IPA's ongoing advocacy to ensure access amid concerns from Iowa pharmacies of recent unworkable Part D contracts and the 2024 DIR cliff. Senator Grassley filed an amendment to the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, providing additional legislative oversight related to implementation of CMS' DIR rule.

The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act passed the markup hearing unanimously, with one abstention. The legislation contains broader PBM provisions and is expected to be combined with the Modernizing and Ensuring PBM Accountability (MEPA) Act. For more on these PBM proposals and what more needs to be done to protect pharmacies, read APhA's letter to the Senate Finance Committee here. 

A timeline of IPA and Senator Grassley's efforts below:

• April 24, 2023: Medical Associates Pharmacy in Boone hosts Senator Grassley and conveys concerns of expected cash flow issues as a result of PBMs responding to CMS rulemaking effective January 1, 2024. 

• July 25, 2023: Following further outreach from pharmacies, Senator Grassley seeks information on the agency's oversight strategy ahead of its rulemaking going into effect in a letter to CMS. 

• July 26, 2023: At a Senate Finance Committee hearing, Grassley amplifies concerns about the challenges the regulatory changes will pose for rural Iowa pharmacies. 

• September 28, 2023: Following a September 22 phone conversation with CMS Administrator Brooks-LaSure, Grassley urges the agency to coordinate with PBMs on payment plans for rural pharmacies that are facing financial burdens connected to upcoming regulatory changes. 

• October 12, 2023: At Grassley's request, CMS meets with the Iowa Pharmacy Association. 

• October 19, 2023: IPA calls on Iowa pharmacists to educate on expected pharmacy closures. IPA also encouraged other state pharmacy associations to engage their Senators on the Finance Committee to urge CMS to take preventative action. 

• October 26, 2023: Senator Grassley and Iowa pharmacists call on CMS to uphold its commitments to rural pharmacies amid upcoming regulatory changes.  

• November 6, 2023: CMS publishes a public memo titled, “Application of Pharmacy Price Concessions to the Negotiated Price at the Point of Sale Beginning January 1, 2024.” 

• November 7, 2023: Grassley proposes an amendment and speaks to IPA's efforts with CMS during the Senate Finance Committee markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act. 

IPA continues to work with Iowa's state and federal lawmakers and regulators toward solutions for pharmacies impacted by these issues. Contact your lawmakers today to share examples of the issues facing your practice, provide data quantifying the impact, and share IPA's legislative priority resources.  

 For more on what you can do to make your voice heard, see below: 

• Email your state legislators with IPA's ‘Leave-Behind' materials; 

• Iowa's Pharmacists Leave-Behind 

• IPA Legislative Priorities Leave-Behind 

• Summary of the State of Community Pharmacy in Iowa Data 

• Set up a meeting to educate them on IPA's legislative priorities; 

• Invite them on a tour of your pharmacy; and  

• Offer to be an ongoing resource on healthcare legislation!  

Contact Seth Brown (sbrown@iarx.org) for questions or assistance.