In brief: Protect indie pharmacies, comment on NIV decision, fill sleep education gaps 

WASHINGTON – A group of senators has introduced legislation to limit what they say are abusive pricing practices by pharmacy benefit managers. 

The “Protecting Pharmacies in Medicaid Act,” introduced by Sens. Peter Welch, D-Vt., Roger Marshal, R-Kan., Mark Warner, D-Va., and Bill Cassidy, R-La., cracks down on what they call “spread pricing” - charging Medicaid more than PBMs charge pharmacies for a drug, driving up costs for Medicaid and short-changing pharmacies. The legislation would save Medicaid an estimated $2 billion over 10 years, they say. 

“Pharmacies are essential to the care and wellbeing of our rural communities,” Welch said. “But spread pricing by pharmacy benefit managers is making it harder than ever for community pharmacies to stay in business and lining the pockets of middlemen. This bill takes an important step to limit PBMs’ abusive pricing practices, protect our pharmacies and support our rural communities. I’m grateful to have Senators Marshall, Warner, and Cassidy’s partnership on this bipartisan legislation to protect the health of Vermonters and Americans across the country.”   

The legislation would require Medicaid’s payments to PBMs to be passed directly to pharmacies, excluding administrative fees. It would also requires all pharmacies participating in state Medicaid programs to report National Average Drug Acquisition Costs (NADAC) to increase transparency in drug pricing and ensure reimbursements to pharmacies reflect the true costs of prescription drugs.   

The legislation is endorsed by the Food Industry Association, National Association of Specialty Pharmacy, National Association of Chain Drug Stores and the National Community Pharmacist Association. 

“Time and time again, PBMs have been caught using tactics like spread pricing to take advantage of the system, lining their pockets while harming patients and the taxpayers they are supposed to serve,” said B. Douglas Hoey, CEO of the NCPA. “Through spread pricing in Medicaid alone, PBMs can cost taxpayers hundreds of millions of dollars each year. These policies nearly made it through Congress at the end of last year. That is why we are grateful for Senators Welch, Marshall, Warner and Bill Cassidy for introducing the Protecting Pharmacies in Medicaid Act, which not only promotes transparency and prohibits spread pricing, but it makes sure pharmacies are paid fairly, allowing them to continue serving their communities.”   

• Learn more about the Protecting Pharmacies in Medicaid Act.  
• Read the full text of the bill. 

CMS seeks comments on NIV decision 

WASHINGTON – CMS has released a proposed decision in response to the request for reconsideration of NCD 280.1 to establish coverage policies for the use of noninvasive home mechanical ventilators and respiratory assist devices for Medicare beneficiaries with COPD.  

Read CMS’s proposed decision here.  

The decision, according to AAHomecare, includes expanded coverage for RADs - with and without a backup rate feature - and home mechanical ventilators. Notably, the association says, it proposes coverage for HMVs in volume-targeted mode for individuals with CRF due to COPD who meet specific clinical criteria. 

CMS, which will develop a new national coverage determination section, is soliciting public comment on the decision until April 10.  

“We are particularly interested in comments that include scientific evidence, specifically any peer-reviewed literature, that describes the role of BPAP or HMVs in the home management of chronic respiratory failure in patients with COPD,” the agency stated. “We are also interested in aspects of health disparities and health equity that should be considered in the review.”  

The request to reconsider NCD 280.1 was made by The Optimal Noninvasive Ventilation Medicare Access Promotion Technical Expert Panel (TEP) consisting of representatives from the American College of Chest Physicians, the American Academy of Sleep Medicine, the American Association for Respiratory Care and the American Thoracic Society.    

CMS opened an initial public comment period on the request in September and plans to complete its analysis in June 9, 2025.  

• Read CMS’s proposed decision memo here.  
• Submit comments on its decision here.   

NSF wants to address ‘gaps’ in understanding of sleep apnea 

WASHINGTON – Nearly one-third of adults diagnosed with sleep apnea are not currently receiving treatment, according to a new study from the National Sleep Foundation.  

“Understanding Sleep Apnea Survey,” an independent research and report supported by Inspire Medical Systems, surveyed more than 1,000 U.S. adults to identify the public's current understanding of and attitudes about sleep apnea symptoms, treatment options and preferences, and consequences of untreated sleep apnea.  

Key findings from the research revealed: 

• Nearly 9 in 10 adults (88%) say sleep apnea is a serious medical condition that is important to treat, yet nearly one-third (31%) of those already diagnosed with sleep apnea are not currently receiving treatment. 
• 78% of Americans aren't aware of all the treatment options available for sleep apnea. Nearly 9 in 10 adults (88%) recognized CPAP therapy, but more than 40% weren't aware of options like surgery, implantable devices and medication, among other approved treatments. 
• 1 in 4 Americans can only identify a few health consequences of untreated sleep apnea, despite untreated sleep apnea being linked to poor cardiovascular, metabolic and cognitive health. 

"National Sleep Foundation is concerned about the impact of undiagnosed and untreated sleep apnea on our nation's health,” said John Lopos, NSF CEO. “It's a serious public health concern that affects tens of millions of Americans, and the public regularly asks NSF for education about the disorder. By finding and addressing gaps in the public's understanding, attitudes, and actions about sleep apnea, we're doing our part to help people ultimately get to a clinical professional and take the right steps towards treatments they may need." 

SuperCare improves workplace satisfaction 

CITY OF INDUSTRY, Calif. – SuperCare Health reports workplace satisfaction has improved in the first quarter of this year compared to the fourth quarter last year after the company made significant changes. SuperCare made the changes after a pulse survey of employees showed a desire for elevated teambuilding, connection and belonging at work. “2024 was a year of transformation for SuperCare Health,” said Mya Moran, senior of manager of marketing. “We truly listened to our team members and implemented their feedback. Our adaptability and commitment have allowed us to meet challenges with resilience, grow as an organization, and make a meaningful impact on the communities we serve. Together, we are building a stronger organization and a company culture rooted in care, innovation, and growth.” SuperCare shared news of the improvement in workplace satisfaction in honor of National Employee Appreciation Day on March 7. The company highlighted ways in which employees have come together, including to support those affected by the LA fires and adopting families during the holidays. “These accomplishments reflect the heart of SuperCare Health - our people,” said John Cassar, CEO and owner. “It is because of our employees that we are able to continue supporting our communities and advancing respiratory care. As we recognize each and every one of our team members on Employee Appreciation Day, let’s celebrate not only the milestones we’ve achieved together, but also the shared purpose that drives us forward.” 

Trinity Biotech zeroes in on CGM 

DUBLIN – Trinity Biotech, a commercial-stage biotech company focused on human diagnostics and diabetes management solutions, including wearable biosensors, has appointed Barclays Capital as its exclusive financial advisor to support its ongoing strategic realignment, including its increased focus on continuous glucose monitoring technology. As part of this effort, Barclays is now actively assessing how the company’s existing businesses can best align with this new strategic direction. “Over the past year we have focused on proving the technological and market feasibility of building a large scale, innovative global CGM business,” said John Gillard, CEO and president. “Our strong pre-pivotal clinical trial data and the keen market interest for our more affordable, user-focused and sustainable CGM solution gives us confidence that this is a vast and compelling opportunity for Trinity Biotech and our investors. At the same time, our strong execution of the company’s ambitious comprehensive transformation plan is poised to provide us with a portfolio of operating businesses with significantly improved financial prospects. Given this progress, now is the right time to explore how we can strategically allocate capital, optimize our balance sheet, and sharpen our focus on CGM growth.” The successful execution of Trinity Biotech’s comprehensive transformation plan is expected to drive near-term profitability improvements, creating potential opportunities to optimize its portfolio and support CGM-related growth. Trinity Biotech sells direct in the United States and through a network of international distributors and strategic partners in over 75 countries worldwide. 

Encore integrates Nexus with cloud-based platforms 

LIVINGSTON, Tenn. – Encore Healthcare has integrated its Nexus program with React Health, Mōvair and Philips cloud-based ventilator management platforms. These integrations mark the first of several integrations that will significantly reduce the workload for HME providers managing ventilator patients, allowing for streamlined compliance management, the company says. “Our mission at Encore Healthcare is to continuously innovate and drive better outcomes for patients with chronic respiratory conditions,” said Zach Gantt, CEO of Encore Healthcare. “By integrating Nexus with these leaders in respiratory equipment, we are breaking down data silos and enabling providers to make more informed decisions, leading to improved patient care and operational efficiencies. Soon we will be integrated with all but one of the primary ventilator manufacturers on the market.” Nexus, Encore Healthcare’s flagship respiratory management program, empowers health care providers with real-time insights, remote patient monitoring and data-driven decision-making tools. The integrations will allow respiratory therapists, physicians and care teams to track therapy compliance, adjust treatment plans in real time and engage patients more effectively, all while ensuring secure and compliant data sharing.  

Henry Schein recognized for Special Olympics support 

MELVILLE, N.Y. – Henry Schein is supporting the Special Olympics Healthy Athletes screenings at the Special Olympics World Winter Games March 8-15, 2025, in Turin, Italy, by donating a range of oral health and medical products. Healthy Athletes offers free health screenings and education to participating Special Olympics athletes. The goal of the program is to identify and address unmet health needs for people with intellectual and developmental disabilities (IDD) and provide referrals for follow-up care while also promoting healthy lifestyle choices. “At Henry Schein, we are strongly committed to ‘help health happen’ and to create shared value for society,” said Jennifer Kim Field, chief sustainability officer at Henry Schein. “We are honored to support Healthy Athletes – alongside Special Olympics and health care providers – to provide convenient access to quality health care and to ensure a healthier future for Special Olympics athletes who are often at higher risk for experiencing health disparities.” The donations to Special Olympics Healthy Athletes are an initiative of Henry Schein Cares, the company’s global corporate citizenship program.  

• Related: Community is 'built into fabric' at Henry Schein