LIPA ANNUAL REPORT - FINAL PROOF by David Neilson

WHO IS

The Louisiana Independent Pharmacies Association (LIPA) was founded in 2001 to promote the growth and prosperity of independent pharmacies across Louisiana. Our network of community pharmacies reports that membership in LIPA is both informative and beneficial to their operations. LIPA’s membership is comprised of independent, community pharmacies serving patients all over Louisiana. The healthcare industry is constantly evolving, and the maintenance of patient access to community pharmacies requires active and effective representation on several fronts. Hundreds of pharmacy owners in Louisiana entrust this representation to LIPA. In turn, LIPA maximizes their return and works on behalf of their needs, issues, and concerns. Effective representation is very important to the growth and prosperity of the pharmacy profession, but especially for independents. LIPA has experienced both historical and recent successes which are primarily driven by our commitment to advocacy at all levels of government, our advancement of outreach to important organizations across the United States, and our pledge to provide valuable resources for all member pharmacies to use to their advantage.

Over the last two decades, LIPA members have benefited from our longstanding relationships with Louisiana and federal governmental agencies. The La Department of Health, Department of Insurance, and Board of Pharmacy, as well as other agencies, have worked with LIPA extensively to protect the interests of independent pharmacies in our state. Meanwhile, the national spotlight on issues like PBM reform has allowed LIPA the opportunity to work with federal agencies including the U.S. Department of Health and Human services, the Centers for Medicare and Medicaid Services, the Federal Trade Commission, and others. Our ability to advocate on behalf of our members is benefited greatly by our evolving relationships with these important agencies.

LIPA membership provides pharmacists the

chance to experience some excellent outreach opportunities. We diligently gather for LIPA regional meetings across the state to allow members to connect with other pharmacists, legislators, and others from their local area. LIPA members can also attend the annual LPA convention, which we sponsor each year, through their LIPA membership. Likewise, the annual NCPA Conference provides our pharmacists the chance to gather with community pharmacists from across the United States. LIPA outreach projects are a great way for our members to connect with other pharmacists and important stakeholders.

In many cases, a great way LIPA can assist member pharmacists is with the “little things.” We provide a number of resources to our members that make their jobs just a little bit easier. LIPA has partnered with LDH in the current Medicaid Unwind Project, the “Shot for $100” vaccine gift card program, and many others. We also offer benefits such as free membership into the Louisiana Pharmacists Association and, upon request, the National Community Pharmacists Association. Among the most utilized LIPA benefits are our support and assistance with audits, complaints, NADAC Appeals, and DME Surety Bonds. Finally, LIPA is also an ACPE accredited organization, meaning we provide our members with several opportunities to earn continuing pharmacy education hours each year.

This report will elaborate on many of the benefits of LIPA membership; however, these are only a few ways we have been able to benefit our members in the last few years. LIPA has served the independent, community pharmacists of Louisiana for the last twenty-two years and will continue to do so at the highest level now and into the future.

LETTER FROM THE BOARD CHAIR

BY DAVID OSBORN, RPH (CHAIR) BOARD REPRESENTATIVE AT-LARGE

When we first set out to provide a forum to help keep Louisiana independent pharmacies alive and strong within the state, there were a myriad of problems within the profession. We were seeing decreasing involvement from independent pharmacists in the organizations that were meant to represent them and recognized the need for a greater “voice” for independent pharmacies. Since 2001, LIPA has worked diligently to be that voice for independent pharmacies across Louisiana.

The founding members of LIPA would tell you that one of the main goals from the outset was to educate the healthcare community, including pharmacists, patients, and other stakeholders on the important issues surrounding independent pharmacy. These same conditions we saw in 2001 – domination by third-party payers – I continue to see here in 2023, and I know you do as well.

This makes our efforts at LIPA just as important today as they were over twenty years ago.

A question many of you may have is how LIPA has achieved these goals and worked to change the conditions of the profession. I am proud of the fact that our state has been able to implement laws and regulations to rein in these huge corporations that are threatening our viability. Attaining the respect of the senators and representatives in the legislature took time, and as our association has grown, we have been able to utilize these relationships to bring forth valuable solutions to protect our patients in the community. Our success in facilitating independent pharmacists’ interaction with legislators to educate them on key issues has paid dividends that will continue for years to come. I am proud of our achievements here, which you can read about in this report, and encourage you all to continue fighting the good fight..

The daily communication and assistance that LIPA has been able to provide to its members is often regarded as one of the greatest strengths of the organization. I certainly agree with this assessment and know that continuing along this blueprint into the future will keep all of our members educated and informed while ensuring that the LIPA team can react quickly to any situations that may arise. Our organization has taken on this tough task for the last twentytwo years. I trust that this effort will continue moving forward.

LIPA’s successes since its inception have allowed it to become a blueprint for other states looking to form their own independent pharmacy organizations. I hear regularly from members about the actions that LIPA has taken to stay involved with other matters outside of Louisiana and on a national level. I’m looking forward to seeing how LIPA continues to work as trailblazers in the profession.

ADVOCACYefforts our

STATE LEGISLATURE

LIPA has been active and engaged with the Louisiana State Legislature for nearly 20 years. We have taken massive strides recently to bring transparency to the prescription drug market and prohibit harmful, opaque PBM activity. Our founding members also cite several significant triumphs in the earlier days of LIPA that pharmacists in Louisiana still enjoy today: ensuring that pharmacies receive payment within a 14day window (prompt pay); requiring PBMs to be regulated by the state; any-willingprovider provisions to increase patient access in the Medicaid program; and capping the occupational license tax fee at an amount less than $2,000 for independent community pharmacists.

These early achievements helped LIPA establish a strong working relationship with legislators and paved the way for many of our more recent successes. More recent accomplishments include: a prohibition on clawbacks; PBM audit guard rails; the ability to offer the cash price as lower cost alternative; the option to decline to fill; requiring PBMs to provide and update MAC lists; and the expansion of unfair trade practices by PBMs and the regulation thereof. We also played a key role in the passage of legislation to address reimbursement concerns within the State Medicaid Program, including the creation of the Medicaid Pharmacy Reimbursement Council within LDH.

Despite strong opposition from PBM lobbying groups over the last three years, LIPA has also pushed for legislation to add clarity to our pharmacy audit laws in response to unnecessarily burdensome PBM audit practices. Essentially, it would make the audit process more efficient by requiring a time limit for pharmacy audits and an attestation prior to audits, as well provide for the compensation of auditors. We truly believe that this legislation, once made into law, will make the audit process more efficient and effective while ensuring pharmacies are not taken advantage of.

The PBMs also aggressively pushed this year to

have incentive programs put into Louisiana law with the introduction of SB171. LIPA fought tooth and nail against this because we all have seen how detrimental these “incentive” programs have been in the past. You may recall, the big PBMs first sold DIR fees as a way to improve patient care by paying pharmacies to meet incentive goals. Excessive DMEPOS accreditation costs also come to mind. In response to these challenges, the LIPA team worked with the Louisiana Legislature to draft Act 423 in 2018 (R.S. 22:1651), which prohibits insurers or pharmacy benefit managers from requiring any license, accreditation, affiliation, or registration beyond what is mandated by federal or state governments. This legislation is critical to safeguard patient access to care and ensure that additional requirements imposed by insurers or benefit managers do not impede pharmacies from providing necessary services. Thanks to the relentless effort of our staff and members, the bill failed to pass the House. Given the historical data and experiences with incentive programs and their impact on pharmacies, it is evident that the reimbursements offered through these programs often fail to cover the costs associated with these special incentive programs. This creates a financial burden on pharmacies and negatively affects their ability to continue providing essential services to the community.

CONGRESS

LIPA members, particularly the board members and your staff, have been very focused on legislation pending in the halls of Congress, including multiple pieces that have already been introduced in our State Legislature as well as several other states.

Just this year, several bills that your LIPA team has worked on, including legislation from Senator Bill Cassidy (R-LA), passed the US Senate Health, Education, Labor, and Pensions (HELP) Committee following testimony from the CEOs of Eli Lilly, Novo Nordisk, and Sanofi, along with senior leadership of each of the three big PBMs.

The work pharmacists have done over the last decade to bring attention to PBMs, and their shellgame tactics that increase costs to patients across the

country, are finally bearing some fruit. We’ve got to stay on track to ensure that we are attentive to the potential changes to legislation through amendments and other considerations; the introduction of legislation is just a start. Legislation gets committee hearings, public views, and comments.

Just as you have frequently stepped up and come to the state capitol, you have LIPA board members and staff regularly working on this legislation nationally and in other states. We work with other states to show that our pharmacists can cooperate and that our challenges are not limited to one area or one state. Sharing the widespread impact of these issues is essential to encourage our federal government to recognize the need for action. While our state legislature meets in a rushed format and adjourns after just a few months in session, Congress meets for a two-year session.

FEDERAL TRADE COMMISSION

Until last year, the Federal Trade Commission (FTC) had taken little to no action to regulate anticompetitive practices, especially relating to PBMs. When they announced in June of 2022 that they would be conducting a Section 6(b) investigation of PBMs, LIPA staff and members began preparing relevant information to support their investigation. This 6(b) study allows FTC to dive into the most notable PBMs without a specific law enforcement purpose. The FTC was also open to public comments, which LIPA and our members utilized to great effect. In a collaborative effort with our federal partners at NCPA, LIPA has played an integral role in the FTC investigation. We have been able to discuss PBM unfair practices in more detail with the FTC and have submitted public comments that detail the importance of independent pharmacies and how PBMs work to damage the impact of these independents. We have clearly made great progress with this FTC investigation as they plan to enforce fair competition and police PBM practices much more closely now and in the future. The impact of LIPA staff and member work with the FTC is best exhibited by the following quote:

“When you actually look . . . it’s actually independent community pharmacies that are outcompeting the big chains, be it on quality of service, be it on price, be it on wait times”

- Lina Khan, FTC Chairwoman

LDH/MEDICAID

Since its inception, LIPA has worked closely with public officials from the Louisiana Department of Health (LDH), including several working for the state’s Medicaid Program. Through collaboration with LA Medicaid, CMS, and other stakeholders, Louisiana was able to pass State Plan Amendments to discuss matters of interest to our

membership, such as ingredient cost reimbursement concerns, inflationary adjustments for the professional dispensing fee, standalone vaccine counseling, and recommended protocol for denied pharmacy claims when a prescriber is rejected due to enrollment status. Additionally, LIPA sent a letter to the Medicaid Director and the LDH Pharmacy Director in June of 2022 after several member pharmacies reported high credentialing fees from PBMs in the MCO space to be credentialed in their networks.

DOI

We also regularly interact with the Louisiana Department of Insurance (DOI) on a variety of matters. The LIPA team regularly meets with the Commissioner and LDI staff concerning suspicious activities we see PBMs engaged in across our state. Over the last year, we have had ongoing discussions with the Commissioner regarding over 70,000 complaints we filed on behalf of our pharmacies. Our complaints detail the various ways we believe ExpressScripts has violated Louisiana law and conducted its business with independent pharmacies poorly. Such violations include, but are not limited to, paying claims outside the prompt pay window, failing to pay the $.10 provider fee and also failing to list adjustments on a claim-by-claim basis. Consequently, LDI submitted a Cease & Desist to ESI following their admission of guilt regarding over 1.2 million prompt pay violations. LDI reports this investigation is ongoing, so we are hopeful that more will be brought to light.

OUTREACH OUTREACH

Part of LIPA membership is a guaranteed connection with other independent pharmacists in your district, in Louisiana, and across the United States. LIPA helps to foster these connections with pharmacy stakeholders

through a wide variety of events throughout the year such as regional meetings, LPA and NCPA conventions, and more.

REGIONAL MEETINGS

About once every year, the LIPA staff and members gather for a series of regional meetings across Louisiana. These meetings are a fantastic way to make new connections, strengthen old ones, and express your concerns regarding the current state of the practice of pharmacy and the pharmaceutical industry. It is also a great time to educate state and federal officials and ask for their support on important legislation. In a typical regional meeting, attendees will have the chance to voice their concerns to LIPA board members and the

legislators representing their districts. In the last year, our members have met with many State Senators and Representatives from across the state, These meetings resulted in some positive outcomes for pharmacists such as the introduction and support of legislation that would regulate the practices of PBMs. Regional meetings play a huge role in our ability to really create change in Louisiana on behalf of the profession.

CONVENTIONS

LIPA membership guarantees that you will be able to attend the LPA annual convention each summer. LIPA is one of the main sponsors of the event and allows members to participate in the convention, the LPA golf tournament, continuing education programs, and more productive activities throughout the weekend. Like the LIPA regional meetings, this convention offers pharmacists the chance to make new connections with pharmacists in Louisiana and strengthen their existing connections.

Likewise, the NCPA annual convention also creates a venue for our members to meet and connect with other pharmacists across the United States. NCPA is our federal partner, so our members are invited to these annual meetings. The opportunity to attend both the LPA and NCPA Conventions is a wonderful benefit of your LIPA membership that should be taken advantage of.

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PARTNERSHIPS

LIPA members have had the opportunity to partner with a series of beneficial organizations and programs.

Right now, LIPA is on the front lines of the Medicaid Unwind Project. LDH recognizes that pharmacies are ideally situated to assist their Medicaid patients who continue to qualify for Medicaid in successfully navigating their upcoming annual renewal of eligibility. LIPA has worked LDH and People Care to develop a “menu” of outreach activities that independent pharmacies can provide and receive compensation to cover their costs. This is a “win-win” for both your patients and your pharmacy.

LIPA also played a key part in the distribution of COVID vaccines to pharmacies and patients during the pandemic. LIPA was enrolled with LDH as a Vaccine Redistribution Center and stocked both Moderna and Pfizer vaccines. Local Louisiana pharmacies have proven to be innovative and readily accessible healthcare providers as we saw at the onset of the pandemic. Various stakeholders did not believe that our independent pharmacies could safely and effectively store, distribute, and administer COVID-19 vaccines and similar treatments. LIPA was able to acquire the necessary equipment to securely store these vaccines and continuously run deliveries to pharmacies throughout the state. We were able to distribute over 25,000 vaccines to our independent pharmacies to meet their communities’ critical need for vaccines. We also participated in LDH’s “Shots for 100” program that incentivized Louisiana citizens to get vaccinated amid the pandemic for a $100 gift card. Along with vaccines, we issued thousands of gift cards to participating pharmacies statewide.

LPA AND NCPA MEMBERSHIP

LIPA membership benefits include paid membership in the Louisiana Pharmacy Association (LPA) and, upon request, the National Community Pharmacies Association (NCPA). LPA offers Continuing Pharmacy Education and Professional Development, Networking, Resources, and more to pharmacies across Louisiana. LIPA is a major sponsor of the LPA Annual Convention, which has provided an important venue for interaction between pharmacy providers, LPA members, and other registered professionals in Louisiana for over a century. Likewise, NCPA membership connects you to over 19,400 other member pharmacies, offers additional Continuing Education, and advocates on behalf of its members in the federal government. NCPA is our federal partner, and membership in LIPA guarantees membership in NCPA. The annual NCPA conference is also a wonderful opportunity to connect with community pharmacists around the country. LIPA membership guarantees membership to these helpful organizations and access to their annual conventions.

AMPLICARE RELATIONSHIP

When LIPA began this relationship with iMedicare (currently known as EnlivenHealth, an Omnicell Innovation) more than 10 years ago, it looked to be a good product. It was a membership benefit for a number of years that allowed pharmacists to easily assist patients in shopping for Medicare plans, while also estimating DIR fees prior to adjudication. Unfortunately, iMedicare was sold and resold quite a few times and was operated by multiple different parent companies, eventually becoming EnlivenHealth. We began to have many problems with the program, especially related to data sharing. The company requested a price increase, but also sought to have access to all pharmacy data when it fell under new ownership group EnlivenHealth, an Omnicell Innovation, which is owned by a private equity firm. As we received reports from our members regarding their use of the product, we continued to monitor the situation and assisted our pharmacies by finding opportunities to help them make the best decision for themselves and their patients.

Following the end of our partnership, we offered to cover the costs for any LIPA member that wanted to continue using EnlivenHealth; however, we still wanted to assist members with DIR consultation. At our July 2021 LIPA meeting in Covington, we brought in Utah independent pharmacist Ben Jolley, who has since provided extremely helpful DIR-fee consultation

services to a number of LIPA member pharmacies. He continues to work closely with LIPA today and is a valuable resource for our members.

A LIPA member pharmacy had the following to say after his meeting with Ben Jolley:

“It is truly amazing how knowledgeable he is about all of this. I probably understand 5% of what he is talking about. He programs each plan in there with a specific code, so he knows what he is dealing with, and it is not just “secure horizons” for the plan name, or whatever. He goes into each patient and flags if they’re low-income subsidy eligible (many in LA are and they can change up to 3 times a year, not just during open enrollment). He then goes to the Medicare website for specific parish/county to identify the number of plan participants in that area. He renegotiated contracts directly with part d plans because he showed them, he has 10% of their customers and would move them all to a different plan. He runs specific reports on profitability of plans in his computer to identify areas where he could switch them and make his store way more profitable.”

SUPPORT/ASSISTANCE

Joining LIPA gives members access to a number of valuable support programs and services at no added cost. These programs and services include, but are not limited to, audit and complaint assistance, NADAC Appeals, and the payment of DME Surety Bonds.

Audits and Complaints:

Members may request audit advice and technical support from our legal team to assist in filing complaints to the Louisiana Commissioner of Insurance, the Department of Health, the Department of Justice, and the Office of Group Benefits. Members will tell you that LIPA assistance with audits is a huge help and saves time and money regularly.

NADAC Appeals:

Additionally, the LIPA staff will file Medicaid reimbursement appeals (NADAC Appeals) on behalf

of any member pharmacy upon request. We strongly encourage our members to send us the information for these appeals because the sheer quantity of NADAC Appeals that LIPA has submitted that show drugs below cost has caused CMS to take a deeper look into state-specific drug information in addition to looking at the national average drug prices.

Payment of DME Surety Bonds:

LIPA will also cover payment of Surety Bonds to allow our member pharmacists to sell Durable Medical Equipment (DME) without incurring any additional costs. LIPA members profit 100% when they sell DME because they do not have to cover payment for these surety bonds.

CONTINUING PHARMACIST EDUCATION

LIPA also is an accredited organization through ACPE, meaning that it can offer opportunities for pharmacists to obtain Continuing Pharmacy Education (CPE) credit hours. The Louisiana Board of Pharmacy requires pharmacists to complete a certain amount of CPE credit hours annually, and LIPA provides a number of credit-earning opportunities for its members throughout each year. This can come in the form of members attending meetings featuring guest speakers who address certain topics in the world of pharmacy, completing pharmacy-related activities, and participating in certain LIPA Board Meetings. Occasionally, these opportunities are also offered electronically, granting members the convenience of obtaining CPE credit despite not being able to attend CONTINUED ON PAGE 9

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particular events in person. Recently, LIPA was awarded a six-year CPE accreditation through ACPE that extends through 2029, so members will experience no shortage of chances to earn those much-needed CPE hours in the coming years.

One of the most valuable membership benefits of LIPA is our weekly newsletter. Each Friday, the LIPA staff send a detailed update on important developments affecting the pharmacy industry in the state and nation. This newsletter keeps members informed on important dates and deadlines, valuable pharmacy news, and the most notable developments of the profession. Through the excellent feedback we receive from our members, it is evident that this resource is the best way to remain up to date on pharmacy news.

GROUPME - RAPID RESPONSE TOOL

Every LIPA member automatically has the option to join our Pharmacy Business Practices GroupMe text chat. This chat is constantly in use and allows pharmacists to stay in contact with LIPA staff, as well as other LIPA member pharmacists, on a regular, easy-to-use basis. Our members report that the rapid response GroupMe has been very important in our collective ability to navigate a number of pharmacy issues, most recently the Medicaid enrollment status issue. Access to this tool is a great benefit for LIPA member pharmacists.