Looking Ahead in 2023 for LTC Pharmacy

It’s January! Seems like this month comes around more quickly than ever. A year ago, we all suspected Congress would be in gridlock and it looks like we were mostly right. The modest surprise came in the late innings when Congress passed an omnibus spending bill covering the 2023 fiscal year, which runs through September. This massive $1.65 trillion, four-thousand-page bill was passed just before Republicans took over the House of Representatives with as slim a partisan advantage as the Democrats maintained over the last two years.

While the conservative Republican block in the House bitterly chastised their Senate colleagues for not waiting to fund the government until they became the majority, the deed is done. What’s in this magnum opus? There was not much that directly affected LTC pharmacies, but here are a few items in the funding package of note:

• Removes DEA Restrictions for Prescribing Buprenorphine: This drug has been known to be effective in the treatment of several conditions, including opioid addiction. Prescribers needed special permission from the Drug Enforcement Administration (DEA) to legally prescribe it. The law now removes that authority from the DEA.
• Medicaid Redeterminations: During the public health emergency (PHE) for COVID-19, state Medicaid programs received an additional federal payment match to expand their increasing Medicaid enrollment. The payments were to last until the end of the PHE, now expected to be extended through April. The additional payments were contingent upon states not removing recipients from the Medicaid rolls until the end of the PHE. The law now allows states to begin determining whether current enrollees are eligible beginning in April, regardless of whether the PHE is extended.
• CBO Part D Data Authorization: The bill gives the Congressional Budget Office (CBO) access to Medicare Part D rebate and remuneration data. This is expected to allow the CBO to score legislative proposals more accurately and to estimate costs going forward.

Will 2023 Be More of the Same?

Every Congress lasts for two years. The last Congress, the 117^th, ended at the end of December, and the 118^th began on January 3^rd. The first year of any Congress is the year when major legislation would be most likely to pass. The second year is taken up with the November election and members want to campaign or not do too much controversial business to annoy voters. So, if anything major gets done, this will be the year.

Major legislative agenda items for LTC  pharmacy continue to be obtaining provider status in Medicare and getting a legislative definition of LTC pharmacy. Both items appear to be long shots. Provider status is likely to be evaluated by the CBO as expensive, but the bill to define LTC pharmacy could get attached to other legislation if the CBO determines it won’t be expensive.

Getting anything passed in Congress when the House is controlled by Republicans and the Senate by Democrats requires the issue be critically important, such as funding the government or raising the debt ceiling – or inexpensive. Our issues probably don’t fit that description.

Time for a State-Level Focus?

Success at the federal level may need to be targeted at executive agencies, such as CMS, the FDA, or the DEA. These agencies are more insulated from the hard politics of legislation and often have broad authority to implement changes that can benefit the people we serve.

The states may be more hospitable to our overtures if we can offer solutions to healthcare cost, quality disparities, and access problems. The LTC pharmacy industry has not been aggressive at the state level since 2006, the year Part D took responsibility for dual eligibility in nursing homes. We might want to rethink this. Pharmacists enjoy a good reputation among state legislatures, and the time may be ripe to flex our collective muscles.

X Factors for Legislative Success in 2023

• Stay informed. Make it easier on yourself by subscribing to a newsletter or social media feed that summarizes important issues and updates.
• Stay engaged. Write your legislators about the policies affecting your pharmacy, meet your members of Congress and state legislature – even invite them for a pharmacy tour.
• Don’t give up! We only need to win once. Our opponents must win every time.