NACDS Highlights 2023 Progress, Looks to the Future in CDR Health Care Outlook Column

TO: NACDS Chain Members

FROM: Steven C. Anderson, FASAE, CAE, IOM, NACDS President & Chief Executive Officer

Date: December 7, 2023

Each year, Chain Drug Review releases a “Health Care Outlook” — a special section of its publication featuring myriad organizations’ perspectives on the current issues and emerging trends impacting the healthcare industry. I invite you to read NACDS’ future-focused submission for the 2024 edition of the “Health Care Outlook,” which will appear in the January 8 issue of Chain Drug Review, and which can be found in its entirety below. This year’s column describes the upcoming era of pharmacy with the words: “preserve the core and stimulate progress.” With the support and guidance of the NACDS membership, we have achieved much on behalf of the industry and on behalf of the Americans you serve every day. I want to thank you for your leadership. As we enter 2024 with ever-increasing momentum from 2023, and from NACDS’ 90-year legacy, we look forward to delivering on our priority issues and programs together. 

The Good to Great principles of author and consultant Jim Collins – a great friend of NACDS – stand the test of time. His notion of “preserve the core and stimulate progress” has particular relevance to the healthcare outlook for 2024. 

In fact, when it comes to the future of pharmacy, of health and wellness, and of meeting Americans’ needs, is there a more salient directive for NACDS than to preserve the core of pharmacy, and to stimulate the industry’s progress in broader areas of health and wellness? 

The Imperative: Preserving Pharmacy 

Make no mistake, the time is now to “preserve the core”: the pharmacy. Pharmacies of diverse types and sizes, and the Americans they serve, find themselves at the breaking point, due largely to the “pharmaceutical benefit manipulation” of PBM middlemen. Should the federal and state governments fail to address this adequately, and swiftly, Americans will find themselves lacking the neighborhood locations that remain – to this point – the most accessible and among the most trusted healthcare destinations. 

Further, the federal and state governments need to take further action to sustain the access to pharmacy services that Americans came to rely on, and to expect, during the COVID-19 pandemic. Americans do not see pharmacy access as a “pandemic” issue. Perceptions of pharmacy-access issues do not wither with “pandemic fatigue.” A poll conducted by Morning Consult and commissioned by NACDS between September 9-11, 2023, found that 80% of American adults support their state updating its policies to ensure that Americans permanently have the same access to pharmacy vaccination, testing, and treatment services as during the pandemic. 

The stakes remain extremely high for our industry and for all Americans. Fortunately, NACDS has never been better positioned. NACDS enters 2024 with ever-increasing momentum from 2023, and from NACDS’ 90-year legacy, on our priority issues and programs. 

2023 Progress: Fairness for Pharmacies  

The following stand out among the leading examples of NACDS’ work in 2023 to advance fairness for pharmacies and for Americans: 

• After a long- and hard-fought battle, the settlement of our six-year litigation in Washington State challenging below-cost Medicaid dispensing fees has emerged as an extremely significant victory. With the Washington State Pharmacy Association and the National Community Pharmacists Association, our work led to a truly pro-pharmacy and pro-patient settlement. 

• After another longstanding fight, New York’s transition to Medicaid fee-for-service is an important victory. The transition has been smooth.

• In PBM reform and reimbursement, more than 31 bills across 27 states were enacted in 2023, leading to the adoption of 55 policy changes consistent with NACDS’ principles. This builds on the enactment of more than 100 new state laws combined in 2021 and 2022.  

• Beyond our legislative focus, NACDS also is advocating aggressively for the implementation, enforcement, and oversight of new state PBM reform laws.

• Florida’s PBM reform push was a priority for NACDS, and a true campaign effort helped to position the new law for maximum impact in the state and across the nation. Other highly significant PBM reforms include a South Carolina law, New York regulations, and rate-floor studies in Minnesota and Maryland.

• The dispensing fee increase in Ohio is a positive outcome of the Single PBM program that NACDS helped to achieve.

• At the federal level, many of NACDS’ Medicaid and Medicare PBM Reform priorities are included in legislation that now is working its way through the U.S. Congress.

• NACDS is engaging in important PBM studies and investigations, including those of the Federal Trade Commission and the U.S. House of Representatives Committee on Oversight and Accountability.

• NACDS’ work to hold pharmacies harmless through the Inflation Reduction Act – including the Medicare prescription drug negotiation program – remains extremely important.

2023 Progress: Pharmacy Services  

The following stand out among the leading examples of advancing pharmacy services in 2023: 

• The Biden Administration extended to December 2024 most of the pandemic’s pharmacy access policies made possible by the temporary use of the federal Public Readiness and Emergency Preparedness Act (PREP Act).

• We have federal legislation introduced by committed sponsors in the House and in the Senate – the Equitable Community Access to Pharmacist Services Act (H.R. 1770/S. 2477) – that would make available to Medicare beneficiaries the pharmacist-provided vaccination, testing, and treatment services that states allow.

• In 2023, 53 bills enacted across 33 states have led to 121 policy changes consistent with work to make permanent the pharmacy access made possible by the PREP Act during the COVID-19 pandemic, to expand scope of practice in other ways, and to establish or enhance payment for services.

• Of particular note, Virginia completed its work to make permanent the PREP Act pharmacy access, and established payment for services in the Medicaid fee-for-service and managed care areas.

• Similarly, Kentucky completed its “PREP Act made permanent” work. Kentucky also made important vaccination policy changes that relate to services provided to children in the most vulnerable communities and that relate to fairer pharmacy reimbursement. 

• Massachusetts advanced “PREP Act made permanent” through Board of Pharmacy regulations. Michigan, Montana, and Colorado advanced “PREP Act made permanent” significantly through new laws.

• Illinois made significant advancements in the roles of pharmacists and technicians.

• Maryland and California made possible payment for pharmacy services in the commercial market.

• NACDS was successful in federal action to update the Advisory Committee on Immunization Practices vaccination schedule in a manner that mitigates disruption of RSV vaccine access at pharmacies.

Other Progress 

In addition to the progress described above, the following progress in 2023 deserves a mention: 

• The U.S. Food and Drug Administration extended the deadline for enforcing the last pieces of the Drug Supply Chain Security Act – preventing further drug shortages.

• A federal omnibus bill resolved the coverage gap for antiviral drugs, and improved access to medication-assisted treatment for addiction.

• The INFORM Consumers Act – which seeks to make inroads in combatting organized retail crime – went into effect.

• After years of NACDS advocacy, FDA proposed a rule to amend its prescription drug labeling regulations – to consolidate the written information that pharmacists must provide to patients into one concise, succinct, easy-to-understand document.

Stimulating Progress: “Pharmacy Plus” 

The complement to “preserve the core” is “stimulate progress.” NACDS has focused on this intently for the past two years through the “NACDS 2023” Initiative – which is all about stimulating progress through innovation in health and wellness. Think of this as NACDS’ “Pharmacy Plus” approach to leveraging the “total store” for the “total person.”  

The Association has leveraged the platform of the 2022 White House Conference on Hunger, Nutrition, and Health to vastly expand our engagement with key stakeholders on broad health and wellness issues.  

For example, in 2023 NACDS launched the Nourish My Health consumer health education campaign with leading patient advocates and nutrition experts. NACDS also embarked on a bold effort to shape “food is medicine” policy in collaboration with the prestigious Milken Institute. NACDS also focused on advancing a pharmacy value-based care model and pharmacy data interoperability to support pharmacist-provided clinical services – particularly through an NACDS-commissioned report by Leavitt Partners.   

The relationships and proactive footing that NACDS has established create an extremely strong foundation for building outward and upward in 2024. 

Stimulating Progress: NACDS Events 

Particularly in the 90th Anniversary year of 2023, NACDS’ meetings and conferences shined as the venue for the industry to conduct business. Collaboration and innovation were on display throughout the NACDS Annual Meeting, the NACDS Total Store Expo, and the NACDS Regional Chain Conference. Robust Retail Advisory Board events continue to align suppliers and retailers in the advancement of the Association. With eyes fixed on the future, NACDS also stepped up as a founding member of the new AI Council – which will focus on the ramifications and opportunities related to AI in our industry. 

There is no substitute for the industry gathering to create the understanding, the networks, and the strategies for future success. In fact, while I chose to highlight Jim Collins’ advice to “preserve the core, stimulate progress,” Jim Collins also had this to say at the 2017 NACDS Annual Meeting: 

“NACDS is one of the best-run associations serving one of the most important industries in our country.” 

Looking ahead to 2024, NACDS remains well positioned through its focus on its true identity. NACDS is the membership, and NACDS executes aggressively on the collective and collaborative will of the membership.  

That approach has NACDS ready to preserve the core of pharmacy, and to stimulate progress in health and wellness, in 2024 and beyond.