P4. Analysis of Obama vs. Romney ELECTION GUIDE

Transcription

1 OCTOBER 2012 NCPA PAC UPDATE National Community Pharmacists Association Political Action Committee P1. NCPA Political Action Committee News. P2. Pharmacy Bills Continue to Gain Support in Congress. P4. Analysis of Obama vs. Romney Medicare/Medicaid Proposals. P7. NCPA PAC Supports a Bi- Partisan Roster of Candidates. ELECTION GUIDE NCPA Political Action Committee (NCPA PAC) News IT S OCTOBER AND THE HALLS OF CONGRESS ARE EMPTY! In addition to the Presidency being up for grabs, one third of the Senate and every member of the House of Representatives is at home pounding the campaign trail as they prepare for the upcoming election. While the majority of the nation s attention will be on the presidential election, there will be literally hundreds, if not thousands, of races in that have the potential to impact community pharmacy. The results may have significant implications for the future of the Medicare, Medicaid, and the new health care reform law, all programs of importance for community pharmacy. Presidential Race Update Source: The Cook Political Report Thank you to all of our NCPA PAC supporters this election cycle. As a distinguished PAC member, you should hold your head high. Without your support, independent community pharmacy would have gone unnoticed. The race for President is still close, with both party conventions over and the candidates bounces having largely subsided. With President Obama needing 270 electoral votes to win a second term, the map above outlines the current electoral vote ratings. 100 Daingerfield Road Alexandria, VA

2 Senate Races Update Source: The Cook Political Report Pharmacy Bills Continue to Gain Support in Congress NCPA has continued to educate Members of Congress and their staffs about NCPA s legislative priorities and bills. A list of members that have signed on to each bill is below. Please support these Members of Congress that support Community Pharmacy. Current Senate Lineup: 51 Democrats, 47 Republicans, 2 Independents (33 seats up in 2012) With Democrats holding a majority in the chamber (including independents who caucus with the Democrats) Republicans would need to gain a net of at least three seats four if they fail to win the presidency. And both sides have said it s about a prospect. House Races Update Source: The Cook Political Report Current House Lineup: 240 Republicans, 190 Democrats, 5 Vacancies With Republicans holding a majority, Democrats would need gain a net of 25 seats to take the majority. Political pundits are currently predicting a net shift of between two seats for Republicans and eight seats for Democrats. The Medicare Access to Diabetes Supplies Act (H.R. 1936): H.R would ensure that Medicare beneficiaries will be able to continue to obtain diabetes testing supplies and counseling services they receive from small pharmacies by exempting these pharmacies from the DME competitive bidding program. Seniors would also be able to continue to obtain home delivery of their testing supplies from these same small pharmacies. Lead Sponsors: Rep. Schock, Aaron [IL-18] & Rep. Welch, Peter [VT-AL] Rep. Bachus, Spencer [AL-6] Rep. Berg, Rick [ND-AL] Rep. Boren, Dan [OK-2] Rep. Castor, Kathy [FL-11] Rep. DeGette, Diana [CO-1] Rep. Duncan, John J., Jr. [TN-2] Rep. Ellmers, Renee L. [NC-2] Rep. Gibbs, Bob [OH-18] Rep. Goodlatte, Bob [VA-6] Rep. Griffith, H. Morgan [VA-9] Rep. Harper, Gregg [MS-3] Rep. Hinojosa, Ruben [TX-15] Rep. Jackson, Jesse L., Jr. [IL-2] Rep. Jenkins, Lynn [KS-2] Rep. Kissell, Larry [NC-8] Rep. Latham, Tom [IA-4] Rep. Latta, Robert E. [OH-5] Rep. Lewis, John [GA-5] Rep. Lipinski, Daniel [IL-3] Rep. Luetkemeyer, Blaine [MO-9] Rep. McKinley, David B. [WV-1] Rep. Meehan, Patrick [PA-7] Rep. Pascrell, Bill, Jr. [NJ-8] Rep. Perlmutter, Ed [CO-7]

3 Rep. Peterson, Collin C. [MN-7] Rep. Posey, Bill [FL-15] Rep. Roe, David P. [TN-1] Rep. Ross, Mike [AR-4] Rep. Schiff, Adam B. [CA-29] Rep. Schilling, Robert T. [IL-17] Rep. Scott, David [GA-13] Rep. Terry, Lee [NE-2] Rep. Tonko, Paul [NY-21] Rep. Towns, Edolphus [NY-10] Rep. Westmoreland, Lynn A. [GA-3] The Preserving Our Hometown Independent Pharmacies Act of 2011 (H.R. 1946): H.R would create a more competitive marketplace for the delivery of pharmacy services by enhancing the ability of independent community pharmacies to negotiate with pharmacy benefit managers (PBMs). Lead Sponsor: Rep. Marino, Tom [PA-10] Rep. Aderholt, Robert B. [AL-4] Rep. Andrews, Robert E. [NJ-1] Rep. Bachus, Spencer [AL-6] Rep. Barletta, Lou [PA-11] Rep. Bartlett, Roscoe G. [MD-6] Rep. Bishop, Timothy H. [NY-1] Rep. Boren, Dan [OK-2] Rep. Boswell, Leonard L. [IA-3] Rep. Butterfield, G. K. [NC-1] Rep. Capito, Shelley Moore [WV-2] Rep. Coble, Howard [NC-6] Rep. Crawford, Rick [AR-1] Rep. Ellmers, Renee L. [NC-2] Rep. Emerson, Jo Ann [MO-8] Rep. Fitzpatrick, Michael G. [PA-8] Rep. Fortenberry, Jeff [NE-1] Rep. Gerlach, Jim [PA-6] Rep. Gohmert, Louie [TX-1] Rep. Herrera Beutler, Jaime [WA-3] Rep. Hinojosa, Ruben [TX-15] Rep. Jones, Walter B., Jr. [NC-3] Rep. Kissell, Larry [NC-8] Rep. Lucas, Frank D. [OK-3] Rep. McIntyre, Mike [NC-7] Rep. McMorris Rodgers, Cathy [WA-5] Rep. Michaud, Michael H. [ME-2] Rep. Palazzo, Steven M. [MS-4] Rep. Paul, Ron [TX-14] Rep. Perlmutter, Ed [CO-7] Rep. Platts, Todd [PA-19] Rep. Posey, Bill [FL-15] Rep. Roby, Martha [AL-2] Rep. Rogers, Mike D. [AL-3] Rep. Ross, Dennis [FL-12] Rep. Schiff, Adam B. [CA-29] Rep. Scott, Austin [GA-8] Rep. Smith, Adrian [NE-3] Rep. Welch, Peter [VT] Rep. Westmoreland, Lynn A. [GA-3] Rep. Young, Todd C. [IN-9] The Pharmacy Competition and Consumer Choice Act of 2011 (H.R. 1971/S. 1058): H.R. 1971/S would result in greater choice of pharmacies for consumers. It would provide vital information to health plans to help them better assess whether their PBM is doing all it can to lower prescription drug costs. It would also create fair standards for PBM audits of pharmacies that are understandable and consistent with state laws governing pharmacy practice. Lead Sponsors: Sen. Pryor, Mark [AR] & Sen. Moran, Jerry [KS] Sen. Boozman, John [AR] Sen. Cochran, Thad [MS] Sen. Conrad, Kent [ND] Sen. Johnson, Tim [SD] Sen. Wicker, Roger [MS] Lead Sponsors: Rep. McMorris Rodgers, Cathy [WA-5] & Rep. Ross, Mike [AR-4] Rep. Barletta, Lou [PA-11] Rep. Bishop, Timothy H. [NY-1] Rep. Boren, Dan [OK-2] Rep. Boswell, Leonard L. Rep. Braley, Bruce L. [IA-1] Rep. Castor, Kathy [FL-11] Rep. Connolly, Gerry [VA-11] Rep. Courtney, Joe [CT-2] Rep. Critz, Mark S. [PA-12] Rep. Doggett, Lloyd [TX-25] Rep. Fitzpatrick, Michael G. [PA-8] Rep. Gingrey, Phil [GA-11] Rep. Herrera Beutler, Jaime [WA-3] Rep. Hinchey, Maurice D. [NY-22] Rep. Hinojosa, Ruben [TX-15] Rep. Jackson, Jesse L., Jr. [IL-2] Rep. Johnson, Hank [GA-4] Rep. Jones, Walter B., Jr. [NC-3] Rep. Kildee, Dale E. [MI-5] Rep. Kissell, Larry [NC-8] Rep. Loebsack, David [IA-2] Rep. Marino, Tom [PA-10] Rep. Michaud, Michael H. [ME-2] Rep. Peterson, Collin C. [MN-7] Rep. Scott, Austin [GA-8] Rep. Scott, David [GA-13] Rep. Terry, Lee [NE-2] Rep. Towns, Edolphus [NY-10] Rep. Weiner, Anthony D. [NY-9] Rep. Welch, Peter [VT] Rep. Westmoreland, Lynn A. [GA-3] Rep. Young, Todd C. [IN-9] The Medicare Pharmacy Transparency and Fair Auditing Act (H.R. 4215): H.R would address problematic PBM practices in Medicare by addressing egregious audits and requiring that PBMs audit standards cannot exceed those required by state or federal law. It would also require PBM transparency regarding how PBMs determine their Maximum Allowable Cost (MAC) pricing. Lead Sponsors: Rep. McMorris Rodgers, Cathy [WA-5] & Rep. Ross, Mike [AR-4] Rep. Amodei, Mark E. [NV-2] Rep. Andrews, Robert E. [NJ-1] Rep. Bishop, Sanford D., Jr. [GA-2] Rep. Bishop, Timothy H. [NY-1] Rep. Boren, Dan [OK-2] Rep. Boswell, Leonard L. [IA-3] Rep. Boustany, Charles W., Jr. [LA-7] Rep. Braley, Bruce L. [IA-1] Rep. Butterfield, G. K. [NC-1] Rep. Chu, Judy [CA-32] Rep. DesJarlais, Scott [TN-4] Rep. Doggett, Lloyd [TX-25] Rep. Fortenberry, Jeff [NE-1] Rep. Gerlach, Jim [PA-6] Rep. Griffith, H. Morgan [VA-9]

4 H.R Cont d Rep. Hastings, Doc [WA-4] Rep. Hinojosa, Ruben [TX-15] Rep. Jones, Walter B., Jr. [NC-3] Rep. Kissell, Larry [NC-8] Rep. Latham, Tom [IA-4] Rep. Lipinski, Daniel [IL-3] Rep. Loebsack, David [IA-2] Rep. Marino, Tom [PA-10] Rep. Owens, William L. [NY-23] Rep. Peterson, Collin C. [MN-7] Rep. Poe, Ted [TX-2] Rep. Schakowsky, Janice D. [IL-9] Rep. Schiff, Adam B. [CA-29] Rep. Scott, Austin [GA-8] Rep. Scott, David [GA-13] Rep. Terry, Lee [NE-2] Rep. Welch, Peter [VT] Rep. West, Allen B. [FL-22] Rep. Westmoreland, Lynn A. [GA-3] Rep. Wittman, Robert J. [VA-1] Rep. Young, Todd C. [IN-9] Independent community pharmacists are facing many challenges. The government affairs staff is busy promoting a pro-pharmacy agenda, including fighting against mail order incentives in Tricare, fighting for an exemption to independent community pharmacies from Medicare Part B competitive bidding for diabetes testing supplies, and supporting legislation to require PBM transparency. We make progress on these fronts every day, but we need your engagement. Let members of Congress know there is support for these positions back home. Please visit the NCPA Legislative Action Center at to learn more about how you can be involved. Also, please continue to sign up your patients for Fight4RX (www. fight4rx.org) because patients too are affected by these issues. Please contact Michael Rule at for more information. NCPA Analysis of Obama vs. Romney Medicare/ Medicaid Proposals With Mitt Romney s selection of Wisconsin Congressman Paul Ryan as his running mate, the issue of Medicare and Medicaid entitlement reform will be front and center in the Presidential campaign. And that should be no surprise. The three main Federal entitlement programs Medicare, Medicaid and Social Security comprise a majority of Federal spending, meaning that any serious attempt at Federal deficit reduction will involve major changes to these programs. Independent community pharmacy has a huge stake in potential changes to these programs given that Medicare Part D and Medicaid prescriptions represent about half of the average independent pharmacy s business. While the new Congress would have to make these sweeping changes to these programs, get ready to hear more about turning Medicare into a premium support model, which would likely increase the prevalence of managed care in Medicare. Under this program, seniors would be provided with an annual fixed subsidy to purchase a comprehensive health insurance product from Federally-approved plans. It is possible that policymakers will also make changes to the Medicare Part D donut hole program, which was enacted as part of the Obamacare health care law. The program helps to defray the costs of medications when seniors fall into the infamous Part D coverage gap. We will also hear more about turning Medicaid into a block grant program, which would give states significantly more flexibility in how they administer their Medicaid programs, including their prescription drug programs. Other Medicaid changes could include reducing the matching monies that states receive from the Federal government for traditional Medicaid patients as well as those enrolled in the state children s health insurance program. Finally, repeal of the Obamacare law could eliminate the Medicaid expansion set to begin in 2014, where millions of more Medicaid patients could be added to states Medicaid rolls. Lots of moving pieces, so it s important for community pharmacy to make sure our voice is heard with Members of Congress that will decide the fate of these programs. The following is an analysis of the candidates Medicare and Medicaid proposals as well as predictions as to how these proposals will impact community pharmacists. The data found within the President Obama/Vice President Biden column is an analysis of information released by President Obama, such as the President Obama FY 2013 Budget Proposal, as well as an analysis of the Affordable Care Act (ACA), which was signed into law by President Obama and recently upheld as constitutional by the United States Supreme Court. The data found within the Mitt Romney/Paul Ryan column is a compilation of information released by candidate Mitt Romney as well as information found within Paul Ryan s Chairman s mark of the FY 2013 House Budget Resolution and the Chairman s report entitled, The Path to Prosperity: A Blueprint for American Renewal. Chairman Ryan s budget proposal is included in this analysis due to the fact that Mitt Romney states on his website that the legislation introduced by Paul Ryan, almost precisely mirrors his ideas. (See www. mittromney.com/issues/medicare).

5 Medicare Proposals President Obama/Vice President Biden Proposal Romney/Ryan Proposal Eligibility Age No changes to current eligibility age. Seniors currently over age 55 would remain in the traditional Medicare program. Individuals currently under the age of 55, beginning in 2023, would be eligible for new options. Structure of Medicare No changes to the current structure of Medicare. Would convert the current Medicare program to a fixed federal contribution program. In this program, individuals eligible for Medicare after 2023 could enroll in FFS Medicare or a private insurance plan through a Medicare Exchange. The federal government would pay a portion of the beneficiary s premiums which would be adjusted for geography and health status. Beneficiaries would pay the difference. In its report CBO has cautioned that under the new system, beneficiaries would bear a much larger share of their health care costs than under the current program and private plans would cost more than traditional Medicare due to different payment rates to providers. Part D Prescription Drug Benefit Coverage Gap (Doughnut Hole) Prior to the ACA, most enrollees paid all drug costs during the period between an initial coverage limit and a catastrophic coverage anytime there was a gap in coverage. This gap is known as the doughnut hole. The ACA, which was signed into law by President Obama, phases out the Based on provisions in Chairman Ryan s FY 2012 Budget Proposal as well as statements by Romney that he would repeal the entire ACA, we are assuming that the Romney/ Ryan plan would repeal the provisions in the ACA regarding closing the doughnut hole. doughnut hole and eliminates the doughnut hole in In 2020, 75% of the cost of generic drugs and 25% of the cost of brand name drugs incurred during the coverage gap would be subsidized by Medicare. Identifying/Combatting Fraud, Waste, and Abuse Strong emphasis on reducing fraud, waste, and abuse in Medicare and on electronic health records. Strong emphasis on reducing fraud, waste, and abuse in Medicare. Funds targeted increases in anti-fraud accounts. Medicaid Proposals Structure of Medicaid System Medicaid Waiver Process Medicaid Reimbursement for DME President Obama/Vice President Biden Proposal The ACA expands Medicaid eligibility levels for nonelderly individuals up to 133% of the federal poverty level and increases the federal matching payments for certain groups of beneficiaries effective in Under the United States Supreme Court s recent ruling, expansion of Medicaid is optional for states. Pursuant to the ruling, if a state chooses not to expand its Medicaid program to the newly eligible defined under the ACA, the state will continue to receive its current federal matching payments but not receive the additional incentive federal matching payments. Expands state flexibility to provide benchmark benefit packages. Would implement reimbursement rates for DME based on Medicare rates. Federal reimbursement for Medicaid spending on certain DME services would be limited. Romney/Ryan Proposal Repeals all Medicaid expansion provisions enacted under the ACA. In addition, the current Medicaid program would be converted to a block grant system starting in FY Federal funding to states would increase annually according to inflation. Eliminates waiver process. No changes to current system.

6 Impact On Community Pharmacists Medicare Under the Romney/Ryan proposal Creates a Medicare Exchange: Beneficiaries eligible for Medicare after 2023 would choose either FFS Medicare or private insurance from a Medicare Exchange. Issues Federal Subsidies: Beneficiaries would receive a federal subsidy to be used toward the premiums of the plan that they choose. This subsidy would be for the amount of the second least expensive plan within the Exchange. Increases Managed Care: Providers could see an increase in beneficiaries out-of-pocket expenses and private insurance reimbursement. Beneficiaries might purchase less expensive plans regardless of coverage and may postpone seeking medical treatment. This proposal will likely increase the prevalence of managed care. Increases Medicare Beneficiaries in the Doughnut Hole: If the doughnut hole provisions are repealed, community pharmacists could see more Medicare beneficiaries reaching the Part D prescription drug benefit coverage gap. Medicare Under the Obama/Biden proposal Eliminates Doughnut Hole: Community pharmacists will continue to see the doughnut hole phased out and fully eliminated in Shifts Additional Costs to Beneficiaries: The cost-sharing and out-of-pocket increases in Part B could shift additional costs to beneficiaries resulting in beneficiaries waiting to seek medical treatment. This could decrease payment to providers in the short-term and drive up health care costs in the long-run. Increases Fraud, Waste, and Abuse Efforts: Regardless of whether Obama/Biden s proposal or Romney/Ryan s proposal is implemented, community pharmacists can expect to see increased efforts in targeting fraud, waste, and abuse within Medicare and Medicaid. Medicaid Under the Romney/Ryan proposal Establishes a Block Grant: Generally, block grants offer states more flexibility in administering programs. Proponents of the block grant argue that a state could have the ability to decrease current requirements under Medicaid and relieve some of the state s costly Medicaid burden. Opponents argue that this shift in responsibility would leave the extra Medicaid spending that is over the block grant designated amounts to the states and caution that states may look at decreasing provider reimbursement under Medicaid as a method of meeting this cost burden. Repeals Medicaid Expansion: Community pharmacists would also see a full repeal of the Medicaid expansion found within the ACA. Medicaid Under the Obama/Biden proposal Implements Medicaid Expansion: If a state chooses to expand its Medicaid program to include nonelderly individuals up to 133% of the federal poverty level, community pharmacists could see a drastic increase in Medicaid beneficiaries, depending on their state s current eligibility levels. If an increase in Medicaid occurs, then all the concerns with current Medicaid beneficiaries, such as lower Medicaid reimbursement, will also increase. Decreases DME Reimbursement: The proposal provides very little detail as to the implementation of the Medicaid DME reimbursement provision. However, the President has made statements regarding adopting more efficient payments for DME under Medicaid and proposes this as a cost saver. To be a cost saver, reimbursements to providers could decrease. Congressional Pharmacy Caucus NCPA thanks the leadership of Representatives Cathy McMorris Rogers (R-WA-5) and Mike Ross (D-AR-4) in the U.S. House of Representatives and Senators Jerry Moran (R-KS) and Jon Tester (D-MT) in the U.S. Senate for forming the Community Pharmacy Caucus s that are critical to advancing legislative priorities for community pharmacies. The Caucus efforts extend beyond pushing for passage of legislation to include educating their colleagues and the public about the value of community pharmacies to our health care system. House Community Pharmacy Caucus Co-Chairs Rep. Cathy McMorris Rodgers (R-WA) Rep. Mike Ross (D-AR) Members Rep. Robert Aderholt (R-AL) Rep. John Barrow (D-GA) Rep. Jaime Herrera Beutler (R-WA) Rep. Joe Courtney (D-CT) Rep. Geoff Davis (R-KY) Rep. Lloyd Doggett (D-TX) Rep. Jo Ann Emerson (R-MO) Rep. Jeff Fortenberry (R-NE) Rep. Virginia Foxx (R-NC) Rep. Jim Gerlach (R-PA) Rep. Bob Goodlatte (R-VA) Rep. Tim Griffin (R-AR) Rep. Brett Guthrie (R-KY) Rep. Maurice D. Hinchey (D-NY) Rep. Tim Holden (D-PA) Rep. Jesse Jackson Jr. (D-IL) Rep. Lynn Jenkins (R-KS) Rep. Eddie Bernice Johnson (D-TX) Rep. Walter B. Jones (R-NC) Rep. Steve King (R-IA) Rep. Bob Latta (R-OH)

7 Rep. Dan Lipinski (D-IL) Rep. Frank LoBiondo (R-NJ) Rep. Dave Loebsack (D-IA) Rep. Blaine Luetkemeyer (R-MO) Rep. Carolyn McCarthy (D-NY) Rep. Jim McGovern (D-MA) Rep. Mike McIntyre (D-NC) Rep. Mike Pompeo (R-KS) Rep. Bill Posey (R-FL) Rep. David Price (D-NC) Rep. Tom Reed (R-NY) Rep. Mike Rogers (R-AL) Rep. Mike Ross (D-AR) Rep. Linda T. Sanchez (D-CA) Rep. Aaron Schock (R-IL) Rep. Peter Sessions (R-TX) Rep. Louise Slaughter (D-NY) Rep. Steve Stivers (R-OH) Rep. Glenn Thompson (R-PA) Rep. Paul Tonko (D-NY) Rep. Greg Walden (R-OR) Senate Community Pharmacy Caucus Co-Chairs Sen. Jim Moran (R-KS) Sen. Jon Tester (D-MT) Members Sen. Kent Conrad (D-ND) Sen. Tim Johnson (D-SD) Sen. Bernie Sanders (I-VT) Sen. Charles Schumer (D-NY) Sen. Debbie Stabenow (D-MI) NCPA PAC Supports a Bi-Partisan Roster of Candidates The NCPA PAC is proud to have supported the following candidates who have demonstrated their commitment to our profession, our businesses and our patients. These candidates understand the importance of community pharmacy and together they form the foundation of a Community Pharmacy Majority necessary for legislative success in Congress. We are encouraging pharmacists, their employees and patients to support these candidates on or before November 6th, and to get involved in their campaigns. Shelley Adler (D) NJ 3 Rep. Rodney Alexander (R) LA 5 Rep. Mark E. Amodei (R) NV 2 Rep. Louis J. Barletta (R) PA 11 Sen. John Barrasso (R) WY Rep. Joe L. Barton (R) TX 6 Rep. Charles F. Bass (R) NH 2 Rep. Xavier Becerra (D) CA 34 Rep. Daniel J. Benishek (R) MI 1 Rep. Rick Berg (R) ND AL Rep. Robert Bishop (R) UT 1 Rep. Timothy H. Bishop (D) NY 1 Rep. Diane Black (R) TN 6 Rep. Marsha Blackburn (R) TN 7 Rep. John A. Boehner (R) OH 8 Rep. Jo Bonner, Jr. (R) AL 1 Rep. Mary Bono Mack (R) CA 36 Rep. Leonard L. Boswell (D) IA 3 Rep. Charles W. Boustany, Jr. (R) LA 3 Rep. Bruce L. Braley (D) IA 1 Sen. Sherrod Brown (D) OH Sen. Scott Brown (R) MA Rep. Michael Burgess (R) TX 26 Rep. G. K. Butterfield (D) NC 1 Rep. Dave Camp (R) MI 4 Rep. John B. T. Campbell, III (R) CA 45 Rep. Francisco Canseco (R) TX 23 Rep. Eric Cantor (R) VA 7 Sen. Maria Cantwell (D) WA Sen. Benjamin L. Cardin (D) MD Sen. Thomas Carper (D) DE Matthew A. Cartwright (D) PA 17 Sen. Robert P. Casey, Jr (D) PA Rep. William Cassidy (R) LA 6 Rep. Katherine Anne Castor (D) FL 14 Rep. Steve Chabot (R) OH 1 Rep. Judy Chu (D) CA 27 Rep. Howard Coble (R) NC 6 Rep. Gerald E. Connolly (D) VA 11 Rep. John Conyers, Jr. (D) MI 14 Sen. Bob Corker (R) TN 0 Rep. Joseph D. Courtney (D) CT 2 Rep. Rick Crawford (R) AR 1 Rep. Joseph Crowley (D) NY 14 Rep. Henry Roberto Cuellar (D) TX 28 Rep. Diana L. DeGette (D) CO 1 Rep. John D. Dingell (D) MI 15 Rep. Lloyd Doggett (D) TX 35

8 Rep. Sean P. Duffy (R) WI 7 Rep. Renee Ellmers (R) NC 2 Rep. Jo Ann Emerson (R) MO 8 Rep. Eliot L. Engel (D) NY 16 Rep. R. Blake Farenthold (R) TX 27 Sen. Dianne Feinstein (D) CA Rep. Michael G. Fitzpatrick (R) PA 8 Rep. Jeff Flake (R) AZ Rep. Virginia Foxx (R) NC 5 Rep. James W. Gerlach (R) PA 6 Rep. Christopher Gibson (R) NY 19 Rep. Phil Gingrey (R) GA 11 Rep. Charles A. Gonzalez (D) TX 20 Rep. Robert Goodlatte (R) VA 6 Rep. Samuel B. Graves, Jr. (R) MO 6 Rep. Tim Griffin (R) AR 2 Rep. H. Morgan Griffith (R) VA 9 Michelle Lujan Grisham (D) NM 1 Rep. S. Brett Guthrie (R) KY 2 Sen. Orrin G. Hatch (R) UT Rep. Nan Hayworth (R) NY 18 Rep. Joseph Heck, Jr. (R) NV 3 Sen. Dean Heller (R) NV Rep. Jaime Herrera Beutler (R) WA 3 Rep. Maurice D. Hinchey (D) NY 19 Rep. Ruben E. Hinojosa (D) TX 15 Rep. Kathleen C. Hochul (D) NY 27 Rep. Steny H. Hoyer (D) MD 5 Rep. Tim A. Huelskamp (R) KS 1 Rep. William P. Huizenga (R) MI 2 Rep. Duncan D. Hunter (R) CA 50 Rep. Steve J. Israel (D) NY 3 Rep. Darrell Issa (R) CA 49 Rep. Sheila Jackson Lee (D) TX 18 Rep. Lynn Jenkins (R) KS 2 Rep. Henry C. Johnson, Jr. (D) GA 4 Rep. Walter B. Jones (R) NC 3 Rep. James Jordan (R) OH 4 Rep. Ron Kind (D) WI 3 Rep. Steven King (R) IA 4 Rep. Peter T. King (R) NY 2 Rep. Jack Kingston (R) GA 1 Rep. Adam Kinzinger (R) IL 16 Rep. Lawrence Kissell (D) NC 8 Rep. John Kline (R) MN 2 Sen. Amy Klobuchar (D) MN Rep. Thomas Latham (R) IA 3 Rep. Sander M. Levin (D) MI 9 Rep. John R. Lewis (D) GA 5 Rep. David Loebsack (D) IA 2 Mia Love (R) UT 4 Rep. W. Blaine Luetkemeyer (R) MO 3 Rep. Daniel E. Lungren (R) CA 7 Sen. Joe Manchin, III (D) WV Rep. Thomas Marino (R) PA 10 Rep. Kevin McCarthy (R) CA 23 Rep. Tom McClintock (R) CA 24 Rep. Mike McIntyre (D) NC 7 Rep. Howard P. McKeon (R) CA 25 Rep. David B. McKinley (R) WV 1 Rep. Cathy McMorris Rodgers (R) WA 5 Rep. Patrick L. Meehan (R) PA 7 Sen. Robert Menendez (D) NJ Rep. Michael H. Michaud (D) ME 2 Rep. Timothy F. Murphy (R) PA 18 Rep. Richard Neal (D) MA 1 Sen. Bill Nelson (D) FL Rep. Robert Neugebauer (R) TX 19 Rep. Kristi Noem (R) SD 1 Rep. Richard B. Nugent (R) FL 11 Rep. Devin G. Nunes (R) CA 22 Rep. Patrick Nunnelee (R) MS 1 Rep. William L. Owens (D) NY 21 Rep. Frank Pallone, Jr. (D) NJ 6 Rep. Erik Paulsen (R) MN 3 Rep. Nancy Pelosi (D) CA 12 Rep. Edwin G. Perlmutter (D) CO 7 Scott Perry (R) PA 4 Rep. Collin C. Peterson (D) MN 7 Rep. Thomas E. Petri (R) WI 6 Rep. Joseph R. Pitts (R) PA 16 Jason Plummer (R) IL 12 Rep. Lloyd Poe (R) TX 2 Rep. Jared S. Polis (D) CO 2 Rep. Michael Pompeo (R) KS 4 Rep. Bill Posey (R) FL 8 Rep. Thomas E. Price, M.D. (R) GA 6 Rep. Nick J. Rahall, II (D) WV 3

9 Rep. Thomas W. Reed, II. (R) NY 23 Rep. Dennis Rehberg (R) MT 1 Rep. David G. Reichert (R) WA 8 Rep. Reid Ribble (R) WI 8 Rep. Edward Rigell (R) VA 2 Rep. Martha Roby (R) AL 2 Rep. Michael Rogers (R) AL 3 Rep. Mike Rogers (R) MI 8 Rep. Peter J. Roskam (R) IL 6 Rep. Mike Ross (D) AR Rep. Bobby L. Rush (D) IL 1 Rep. Paul Ryan (R) WI 1 Matt Salmon (R) AZ 5 Rep. Janice D. Schakowsky (D) IL 9 Rep. Adam B. Schiff (D) CA 28 Rep. Aaron Schock (R) IL 18 Rep. Allyson Y. Schwartz (D) PA 13 Rep. Austin Scott (R) GA 8 Rep. Peter Sessions (R) TX 32 Rep. John M. Shimkus (R) IL 15 Rep. Louise McIntosh Slaughter (D) NY 25 Rep. Adam Smith (D) WA 9 Rep. Lamar Smith (R) TX 21 Rep. Steve Southerland (R) FL 2 Sen. Deborah Stabenow (D) MI Rep. Fortney H. Pete Stark (D) CA 15 Rep. Clifford B. Stearns (R) FL 3 Tony Strickland (R) CA 26 Rep. Betty Sutton (D) OH 16 Rep. Lee Terry (R) NE 2 Sen. Jon Tester (D) MT Rep. Glenn W. Thompson (R) PA 5 Tommy G. Thompson (R) WI Rep. Patrick J. Tiberi (R) OH 12 Rep. Fredrick Upton (R) MI 6 Rep. Chris Van Hollen (D) MD 8 Ann L. Wagner (R) MO 2 Rep. Timothy L. Walberg (R) MI 7 Rep. Greg P. Walden (R) OR 2 Rep. Joe Walsh (R) IL 8 Rep. Timothy J. Walz (D) MN 1 Rep. Melvin L. Watt (D) NC 12 Rep. Henry A. Waxman (D) CA 33 Rep. Peter F. Welch (D) VT 1 Brad Wenstrup (R) OH 2 Sen. Sheldon Whitehouse (D) RI Rep. Edward Whitfield (R) KY 1 Sen. Roger Wicker (R) MS Rep. Joe Wilson (R) SC 2 Rep. Robert J. Wittman (R) VA 1 Rep. Kevin W. Yoder (R) KS 3 Rep. Todd Young (R) IN 9 VOTE We ve been fighting for you in the halls of Congress, the courts, and state legislatures across the country. Many of you have made sacrifices to run for elected office, spent hours volunteering for local campaigns or have contributed to candidates. Even if you don t have the resources or time to donate, the most important thing you can do is vote on or before November 6.

10 CONTINUED SUPPORT OF NCPA PAC RAISES THE PROFILE OF INDEPENDENT COMMUNITY PHARMACY! To learn more about NCPA PAC, please contact Karry LaViolette at or Are you willing to give a $1 a day [to the NCPA PAC] to protect your business and your bottom line? Steve Giroux, PAC Chairman, Middleport Family Health Center, Middleport, NY Enrollment Form Yes! I want to protect my pharmacy by helping elect members of Congress who support community pharmacy! Fold and return this form with your contribution to: NCPA PAC, 100 Daingerfield Rd., Alexandria VA For more information, contact: Karry LaViolette, Political Development Director at , fax, or karry.laviolette@ncpanet.org. NAME NCPA MEMBER # COMPANY NAME OCCUPATION HOME ADDRESS CITY/STATE/ZIP PHONE FAX Enclosed is my personal check for a one-time donation, payable to NCPA PAC : $5,000 $2,500 $1,000 $500 $365 (Dollar A Day) Other $ (Partnership and sole proprietorship checks are permitted to PACs; however, corporate funds are prohibited by Federal law.) Please bill my personal credit card: Visa MasterCard American Express Discover CARD # EXP. DATE NAME ON CARD TODAY S DATE SIGNATURE With monthly contributions of: $ (maximum allowed) $250 $100 $75 $50 Other $ Or, with a one-time contribution of: $5,000 (maximum allowed) $2,500 $1,000 $500 $365 Other $ Contributions to the NCPA PAC are not deductible for federal income tax purposes. Contributions to NCPA PAC are used for political purposes. All contributions are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions; you may chose to contribute more or less than the guidelines suggest, and NCPA will not favor or disadvantage you by reason of the amount of your contribution or your decision not to contribute. Only U.S. Citizens (or those who have been lawfully admitted to permanent U.S. residence) are allowed to contribute to NCPA PAC. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. NCPAPAC-2012