Medication Therapy Management Empowerment Act of 2015

H.R. 471 & S. 483 legislation to prevent and reduce prescription drug abuse. H.R. 592 & S. 314, Provide for coverage under Medicare program of pharmacist services. Medication Therapy Management, including S. 776 The Medication Therapy Management Empowerment Act of 2015. H.R.5951 and S. 3308, legislation to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. Pharmaceutical compounding and the implementation of the Drug Quality Security Act.

Client expense: $610,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3762, Restoring Americans Healthcare Freedom Reconciliation Act H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act H.R. 954, CO-OP Consumer Protection Act of 2016 H.R. 1190/S. 141, The Protecting Seniors Access to Medicare Act of 2015 H.R. 1192, National Clinical Care Commission Act H.R. 1270, Restoring Access to Medication and Improving Health Savings Act H.R. 1427, Medicare CGM Access Act H.R. 1686/S. 3082, Preventing Diabetes in Medicare Act H.R. 1707, Access to Frontline Health Care Act of 2015 H.R. 1726, Access to Quality Diabetes Education Act H.R. 1807, Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2015 H.R. 2102, Medicare Diabetes Prevention Act H.R. 2124/S. 1148, Resident Physician Shortage Act H.R. 2603/S. 1475, Saving Lives, Saving Costs Act H.R. 2646, Helping Families in Mental Crisis Act H.R. 2713/S. 3245, Title VIII Nursing Workforce Reauthorization Act of 2016 H.R. 3081/S. 1778, Telemedicine for Medicare Act H.R. 3119/S. 2748, Palliative Care and Hospice Education and Training Act H.R. 3660/S. 3126,Preventive Health Savings Act H.R. 3952/S. 2248, Congenital Heart Future Reauthorization Act of 2015 H.R. 4212/S. 704, Community Based Independence for Seniors Act of 2015 H.R. 4442/S. 2484, CONNECT for Health Act H.R. 4732/S. 2671, Advancing Medical Resident Training in Community Hospitals Act H.R. 4774, Training Tomorrows Doctors Today Act H.R. 4909/S. 2943, National Defense Authorization Act H.R. 5273, Helping Hospitals Improve Patient Care Act H.R. 5414, FDA Cross-Center Collaboration Act H.R. 5447/S. 3060, The Small Business Health Care Relief Act H.R. 5652,Access to Better Care Act H.R. 5681/S. 3137, Alzheimers Beneficiary and Caregiver Support Act H.R. 5713, Sustaining Healthcare Integrity and Fair Treatment Act of 2016 H.R.5926 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2017 H.R. 6043/S. 3335, The Fair Accountability and Innovative Research Drug Pricing Act of 2016 H.R. 6109/S. 3371, Medicare Affordability and Enrollment Act S. 524, Comprehensive Addiction and Recovery Act S. 586, National Diabetes Clinical Care Commission Act S. 603, Jobs and Premium Protection Act S. 776,Medication Therapy Management Empowerment Act S. 1077,Advancing Breakthrough Medical Devices for Patients Act S. 1101,Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 1622,FDA Device Accountability Act S. 2511,Improving Health Information Technology Act S. 2680,Mental Health Reform Act of 2016 S. 2864,Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016 S. 3326,State Flexibility to Provide Affordable Health Options Act S. 3504, Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016 Pub. L. 111-5, The American Recovery and Reinvestment Act of 2009 (Health Information Technology for Economic and Clinical Health Act (HITECH) Pub. L. 111-148, Patient Protection and Affordable Care Act (PPACA) Pub. L. 114-10, Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255,21st Century Cures Pub. L. 114-270, Expanding Capacity for Health Outcomes Act (ECHO) Pub. L. 114-328, National Defense Authorization Act for Fiscal Year 2017

Client expense: $150,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1190/S. 141, The Protecting Seniors Access to Medicare Act of 2015 H.R. 1270, Restoring Access to Medication and Improving Health Savings Act H.R. 1427, Medicare CGM Access Act H.R. 1686/S. 3082, Preventing Diabetes in Medicare Act H.R. 1707, Access to Frontline Health Care Act of 2015 H.R. 1726, Access to Quality Diabetes Education Act H.R. 2102, Medicare Diabetes Prevention Act H.R. 2124/S. 1148, Resident Physician Shortage Act H.R. 2603/S. 1475, Saving Lives, Saving Costs Act H.R. 3119/S. 2748, Palliative Care and Hospice Education and Training Act H.R. 3660/S. 3126,Preventive Health Savings Act H.R. 3952/S. 2248, Congenital Heart Future Reauthorization Act of 2015 H.R. 4212/S. 704, Community Based Independence for Seniors Act of 2015 H.R. 5273, Helping Hospitals Improve Patient Care Act H.R. 5681/S. 3137, Alzheimers Beneficiary and Caregiver Support Act H.R.5926 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2017 H.R. 6043/S. 3335, The Fair Accountability and Innovative Research Drug Pricing Act of 2016 H.R. 6109/S. 3371, Medicare Affordability and Enrollment Act S. 776,Medication Therapy Management Empowerment Act S. 1077,Advancing Breakthrough Medical Devices for Patients Act S. 1101,Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 2864,Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016 S. 3326,State Flexibility to Provide Affordable Health Options Act Pub. L. 111-5, The American Recovery and Reinvestment Act of 2009 (Health Information Technology for Economic and Clinical Health Act (HITECH) Pub. L. 114-10, Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255,21st Century Cures

Client expense: $150,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1270 - Restoring Access to Medication Act of 2015 S. 709 - Restoring Access to Medication Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R. 793 - Ensuring Seniors Access to Pharmacies Act of 2015 H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R.6 - 21st Century Cures Act S.1190 - Ensuring Seniors Access to Local Pharmacies Act of 2015 S. 1913 - Stopping Medication Abuse and Protecting Seniors Act of 2015 H.R.4878 - Better Care, Lower Cost Act S. 3094 - Price Relief, Innovation, and Competition for Essential Drugs Act HR 5573 - Price Relief, Innovation and Competition for Essential Drugs Act H. R. 4641 -To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes. HR 5210-Patient Access to Durable Medical Equipment Act S 2736-Patient Access to Durable Medical Equipment Act of 2016 H.R. 1192 - National Diabetes Clinical Care Commission Act S. 3056 - Creating and Restoring Equal Access to Equivalent Samples Act H.R. 5951- Improving Transparency and Accuracy in Medicare Part B Spending

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

Reducing the costs of pharmaceuticals, medical devices, and supplies for consumers and health care providers, including implementation of the Drug Quality and Security Act (P.L.113-54) and P.L.112-144; support medical device pricing transparency and prohibition on medical device price "gag clauses"; preserving access to group purchasing organizations (GPOs) and protecting the GPO safe harbor; educating policymakers on hospital drug shortages and significant drug price increases and support draft reform legislation; pharmaceutical labeling of generic drugs (FDA-2013-N-0500); legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; support reforming the durable medical equipment competitive bidding program; supporting "any willing pharmacy" legislation; promoting access to biosimilars (labeling/interchangeability); 21st Century Cures Act (H.R.6) - general support for overall bill, support final pharmacy lock-in policy, oppose PPSA weakening of existing requirements, oppose Section 4004 treatment of infusion drugs furnished through durable medical equipment, oppose use of savings from home infusion payment reform for purposes other than creating a Medicare home infusion benefit; Ensuring Seniors Access to Local Pharmacies Act (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Empowerment Act (S.776) - support; Strengthening Medicare Advantage Through Innovation and Transparency for Seniors - oppose; FDA-2014-D-1524-0002 - comments, Administration and Capitol Hill meetings on draft guidance on repackaging of certain human drug products by pharmacies and outsourcing facilities; FDA-2014-N-1459 - comments and Capitol Hill meetings on draft MOU addressing certain distributions of compounded human drug products between states and the FDA; proposed changes to the 340B prescription drug program - oppose; 21st Century Cures Act (H.R.6, now P.L.114-255) - support, but with serious concerns about the misalignment of implementation dates for two home infusion provisions - oppose implementation of Section 5004 (a) without aligning the start date of the new Medicare home infusion service benefit in Section 5012; proposed amendments to 340b program (not ultimately included in H.R.6) - oppose; provide comments on proposed 340b omnibus guidance (RIN 0906 AB08); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913)- support (with some concerns about pharmacy lock-in policy); submitted comments on Management Standards for Hazardous Waste Pharmaceuticals (EPA-HQ-RCRA-2007-0932); meeting with DEA on Controlled Substances Act (21 USC 802); proposed changes to regulation of Laboratory Developed Tests (FDA-2011-D-0360-Draft Guidance for Industry, Food and Drug Administration Staff and Clinical Laboratories: Framework for Regulatory Oversight of Laboratory Developed Tests) - oppose; Comprehensive Addiction and Recovery Act of 2016 ((S.524), monitoring for pharmacy lock-in policy, which includes exemption for LTC) - support; Increasing Competition in Pharmaceuticals Act (S.2615/H.R.4784) - support; CREATES Act addressing REMS abuses (S.3056) - support; submitted comments in response to HRSA proposed rule establishing an Administrative Dispute Resolution (ADR) Process for the 340B Drug Purchasing Program (81 Fed. Reg. 53,381).

Client expense: $400,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns; submitted comments to CMS about its proposal to expand testing of mandatory, risk-based bundled payments for acute episodes of care - oppose; 21st Century Cures Act (H.R. 34, now P.L.114-255) provisions that apply to site neutral, readmissions, and other hospital reimbursement issue - support.

Client expense: $400,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

S. 776 - Medication Therapy Empowerment Act of 2015; H.R. 1021 - Protecting the Management Integrity of Medicare Act of 2015; H.R. 1270 - Restoring Access to Medication Act of 2015; S. 709- Restoring Access to Medication Act of 2015; H.R. 2- Medicare Access and Chip Reauthorization Act of 2015; H.R. 793 - Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 1190 -Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 5951/S. 3308 - Improving Transparency and Accuracy in Medicare Part D Spending Act

Client expense: $245,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Personnel Management (OPM), SENATE

Medicare Part B and D Telemedicine Medicaid CHIP CHIP Re-authorization S.776 Medication Therapy Management Empowerment Act of 2015 HR 2624/S1488 Part D Beneficiary Appeals Fairness Act Part B proposal HR5122

Client expense: $75,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

All legislative and executive actions concerning medication therapy management, pharmacy dispensing fees, drug safety, prescription drug diversion and abuse, drug shortages, supply chain, Medicare Sustainable Growth Rate, Medicaid reimbursement, provider status and any willing pharmacy. HR 793-Ensuring Senior Access to Local Pharmacies Act of 2015, S 776-Medication Therapy Management Empowerment Act of 2015, FY-2016 National Defense Authorization Act, sections related to Tricare. HR 953-Comprehensive Addiction and Recovery Act of 2015, S 524-Comprehensive Addiction and Recovery Act of 2016.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 776, Medication Therapy Management Empowerment Act of 2015. H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act. H.R. 793/S. 1190, Ensuring Seniors Access to Local Pharmacies Act of 2015. H.R. 244, MAC Transparency Act. H.R. 5951/S. 3308, Improving Transparency and Accuracy in Medicare Part D Spending Act.

Client expense: $190,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Environmental Protection Agency (EPA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 471 & S. 483 legislation to prevent and reduce prescription drug abuse. H.R. 592 & S. 314, Provide for coverage under Medicare program of pharmacist services. Medication Therapy Management, including S. 776 The Medication Therapy Management Empowerment Act of 2015. H.R.5951 and S. 3308, legislation to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. Pharmaceutical compounding and the implementation of the Drug Quality Security Act.

Client expense: $310,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 776, Medication Therapy Management Empowerment Act of 2015. H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1270 - Restoring Access to Medication Act of 2015 S. 709 - Restoring Access to Medication Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R. 793 - Ensuring Seniors Access to Pharmacies Act of 2015 H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R.6 - 21st Century Cures Act S.1190 - Ensuring Seniors Access to Local Pharmacies Act of 2015 S. 1913 - Stopping Medication Abuse and Protecting Seniors Act of 2015

Client expense: $580,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1270 - Restoring Access to Medication Act of 2015 S. 709 - Restoring Access to Medication Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R. 793 - Ensuring Seniors Access to Pharmacies Act of 2015 H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R.6 - 21st Century Cures Act S.1190 - Ensuring Seniors Access to Local Pharmacies Act of 2015 S. 1913 - Stopping Medication Abuse and Protecting Seniors Act of 2015 H.R.4878 - Better Care, Lower Cost Act S. 3094 - Price Relief, Innovation, and Competition for Essential Drugs Act HR 5573 - Price Relief, Innovation and Competition for Essential Drugs Act H. R. 4641 -To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes. HR 5210-Patient Access to Durable Medical Equipment Act S 2736-Patient Access to Durable Medical Equipment Act of 2016 H.R. 1192 - National Diabetes Clinical Care Commission Act S. 3056 - Creating and Restoring Equal Access to Equivalent Samples Act H.R. 5951- Improving Transparency and Accuracy in Medicare Part B Spending

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 5506/ H.R. 5942/S. 3090 Dialysis PATIENT Demonstration Act of 2016 (All provisions) H.R. 5659 ESRD Choice Act of 2016 (All provisions) H.R. 270 Flexibility in Health IT Reporting Act (All provisions) S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 MAC Transparency Act (All provisions) H.R. 2507 The Increasing Regulatory Fairness Act (All provisions) S. 2484 CONNECT for Health Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers CMS vascular care rate change proposal CMS/Medicare Advantage ESRD rate formulation

Client expense: $650,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

H.R. 5506/S. 5090 Dialysis PATIENT Demonstration Act H.R. 5659 ESRD Choice Act of 2016 H.R. 270 Flexibility in Health IT Reporting Act (All provisions) S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 MAC Transparency Act (All provisions) H.R. 2507 The Increasing Regulatory Fairness Act (All provisions) S. 2484 CONNECT for Health Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services CMS vascular care rate change proposal CMS/Medicare Advantage ESRD rate formulation

Client expense: $650,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Medicare Part B and D Telemedicine Medicaid CHIP CHIP Re-authorization S.776 Medication Therapy Management Empowerment Act of 2015 HR 2624/S1488 Part D Beneficiary Appeals Fairness Act Part B proposal HR5122

Client expense: $75,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns.

Client expense: $410,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Reducing the costs of pharmaceuticals, medical devices, and supplies for consumers and health care providers, including implementation of the Drug Quality and Security Act (P.L.113-54) and P.L.112-144; support medical device pricing transparency and prohibition on medical device price "gag clauses"; preserving access to group purchasing organizations (GPOs) and protecting the GPO safe harbor; educating policymakers on hospital drug shortages and significant drug price increases and support draft reform legislation; pharmaceutical labeling of generic drugs (FDA-2013-N-0500); legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; support reforming the durable medical equipment competitive bidding program; supporting "any willing pharmacy" legislation; promoting access to biosimilars (labeling/interchangeability); 21st Century Cures Act (H.R.6) - general support for overall bill, support final pharmacy lock-in policy, oppose PPSA weakening of existing requirements, oppose Section 4004 treatment of infusion drugs furnished through durable medical equipment, oppose use of savings from home infusion payment reform for purposes other than creating a Medicare home infusion benefit; Ensuring Seniors Access to Local Pharmacies Act (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Empowerment Act (S.776) - support; Strengthening Medicare Advantage Through Innovation and Transparency for Seniors - oppose; FDA-2014-D-1524-0002 - comments, Administration and Capitol Hill meetings on draft guidance on repackaging of certain human drug products by pharmacies and outsourcing facilities; FDA-2014-N-1459 - comments and Capitol Hill meetings on draft MOU addressing certain distributions of compounded human drug products between states and the FDA; proposed changes to the 340B prescription drug program - oppose; 21st Century Cures Act (H.R.6) - support; proposed amendments to 340b program (not ultimately included in H.R.6) - oppose; provide comments on proposed 340b omnibus guidance (RIN 0906 AB08); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913)- support (with some concerns about pharmacy lock-in policy); submitted comments on Management Standards for Hazardous Waste Pharmaceuticals (EPA-HQ-RCRA-2007-0932); meeting with DEA on Controlled Substances Act (21 USC 802); proposed changes to regulation of Laboratory Developed Tests (FDA-2011-D-0360-Draft Guidance for Industry, Food and Drug Administration Staff and Clinical Laboratories: Framework for Regulatory Oversight of Laboratory Developed Tests) - oppose; Comprehensive Addiction and Recovery Act of 2016 ((S.524), monitoring for pharmacy lock-in policy, which includes exemption for LTC) - support; Increasing Competition in Pharmaceuticals Act (S.2615/H.R.4784) - support; CREATES Act addressing REMS abuses (S.3056) - support.

Client expense: $410,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 6 ,21st Century Cares H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1190/S. 141, The Protecting Seniors Access to Medicare Act of 2015 H.R. 1192, National Diabetes Clinical Care Commission Act H.R. 1270, Restoring Access to Medication and Improving Health Savings Act H.R. 1427, Medicare CGM Access Act H.R. 1686/S. 3082, Preventing Diabetes in Medicare Act H.R. 1726, Access to Quality Diabetes Education Act H.R. 2102, Medicare Diabetes Prevention Act H.R. 2124/S. 1148, Resident Physician Shortage Act H.R. 2603/S. 1475, Saving Lives, Saving Costs Act H.R. 2646, Helping Families in Mental Crisis Act H.R. 3081/S. 1778, Telemedicine for Medicare Act H.R. 3660/S. 3126,Preventive Health Savings Act H.R. 4212/S. 704, Community Based Independence for Seniors Act of 2015 H.R. 4442/S. 2484, CONNECT for Health Act H.R. 4732/S. 2671, Advancing Medical Resident Training in Community Hospitals Act H.R. 4774, Training Tomorrows Doctors Today Act H.R. 4909/S. 2943, National Defense Authorization Act H.R. 5273, Helping Hospitals Improve Patient Care Act H.R. 5395, Expanding Capacity for Health Outcomes Act H.R. 5414, FDA Cross-Center Collaboration Act H.R. 5447/S. 3060, The Small Business Health Care Relief Act H.R. 5652,Access to Better Care Act H.R. 5681/S. 3137, Alzheimers Beneficiary and Caregiver Support Act H.R. 6043/S. 3335, The Fair Accountability and Innovative Research Drug Pricing Act of 2016 S. 524, Comprehensive Addiction and Recovery Act S. 754, Cybersecurity Information Sharing Act (CISA) S. 776,Medication Therapy Management Empowerment Act S. 1077,Advancing Breakthrough Medical Devices for Patients Act S. 1101,Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 1622,FDA Device Accountability Act S. 2511,Improving Health Information Technology Act S. 2680,Mental Health Reform Act of 2016 S. 2864,Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016 S. 3326, State Flexibility to Provide Affordable Health Options Act

Client expense: $140,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 776 - Medication Therapy Empowerment Act of 2015; H.R. 1021 - Protecting the Management Integrity of Medicare Act of 2015; H.R. 1270 - Restoring Access to Medication Act of 2015; S. 709- Restoring Access to Medication Act of 2015; H.R. 2- Medicare Access and Chip Reauthorization Act of 2015; H.R. 793 - Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 1190 -Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act;

Client expense: $335,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Personnel Management (OPM), SENATE

All legislative and executive actions concerning medication therapy management, pharmacy dispensing fees, drug safety, prescription drug diversion and abuse, drug shortages, supply chain, Medicare Sustainable Growth Rate, Medicaid reimbursement, provider status and any willing pharmacy. HR 793-Ensuring Senior Access to Local Pharmacies Act of 2015, S 776-Medication Therapy Management Empowerment Act of 2015, FY-2016 National Defense Authorization Act, sections related to Tricare. HR 953-Comprehensive Addiction and Recovery Act of 2015, S 524-Comprehensive Addiction and Recovery Act of 2016.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug abuse, preferred pharmacy networks, pharmacist provider status, drug pricing and Tricare. Issues related to biosimilars, FDA repackaging and drug disposal. HR 1600 :A bill to amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes. HR 592 - Pharmacy and Medically Underserved Areas Enhancement Act S 314 - Pharmacy and Medically Underserved Areas Enhancement Act HR 244 - MAC Transparency Act S 776 - Medication Therapy Management Empowerment Act of 2015 HR 471 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 S 483 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 HR 6-Stopping Medication Abuse and Protecting Seniors Act of 2015 S 1913-Stopping Medication Abuse and Protecting Seniors Act of 2015 HR 1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S 480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S. 524-Comprehensive Addiction and Recovery Act HR 4909-National Defense Authorization Act S 2943--National Defense Authorization Act

Client expense: $1,158,247 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA)

S. 776 - Medication Therapy Empowerment Act of 2015; H.R. 1021 - Protecting the Management Integrity of Medicare Act of 2015; H.R. 1270 - Restoring Access to Medication Act of 2015; S. 709- Restoring Access to Medication Act of 2015; H.R. 2- Medicare Access and Chip Reauthorization Act of 2015; H.R. 793 - Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 1190 -Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act;

Client expense: $390,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Personnel Management (OPM), SENATE

H.R. 5506/S. 3090 Dialysis PATIENT Demonstration Act of 2016 (All provisions) H.R. 5659 ESRD Choice Act of 2016 (All provisions) H.R. 270 Flexibility in Health IT Reporting Act (All provisions) S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 MAC Transparency Act (All provisions) H.R. 2507 The Increasing Regulatory Fairness Act (All provisions) S. 2484 CONNECT for Health Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers CMS/Medicare Advantage ESRD rate formulation

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

H.R. 5506/S. 5090 Dialysis PATIENT Demonstration Act H.R. 5659 ESRD Choice Act of 2016 H.R. 270 Flexibility in Health IT Reporting Act (All provisions) S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 MAC Transparency Act (All provisions) H.R. 2507 The Increasing Regulatory Fairness Act (All provisions) S. 2484 CONNECT for Health Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services CMS/Medicare Advantage ESRD rate formulation

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

H.R.471 & S. 483 legislation to prevent and reduce prescription drug abuse. H.R. 592 & S. 314, Provide for coverage under Medicare program of pharmacist services. Medication Therapy Management, including S. 776 The Medication Therapy Management Empowerment Act of 2015.

Client expense: $300,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Reducing the costs of pharmaceuticals, medical devices, and supplies for consumers and health care providers, including implementation of the Drug Quality and Security Act (P.L.113-54) and P.L.112-144; support medical device pricing transparency and prohibition on medical device price "gag clauses"; preserving access to group purchasing organizations (GPOs) and protecting the GPO safe harbor; educating policymakers on hospital drug shortages and significant drug price increases and support draft reform legislation; pharmaceutical labeling of generic drugs (FDA-2013-N-0500); legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; support reforming the durable medical equipment competitive bidding program; supporting "any willing pharmacy" legislation; promoting access to biosimilars (labeling/interchangeability); 21st Century Cures Act (H.R.6) - general support for overall bill, support final pharmacy lock-in policy, oppose PPSA weakening of existing requirements, oppose Section 4004 treatment of infusion drugs furnished through durable medical equipment; Ensuring Seniors Access to Local Pharmacies Act (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Empowerment Act (S.776) - support; Strengthening Medicare Advantage Through Innovation and Transparency for Seniors - oppose; FDA-2014-D-1524-0002 - comments, Administration and Capitol Hill meetings on draft guidance on repackaging of certain human drug products by pharmacies and outsourcing facilities; FDA-2014-N-1459 - comments and Capitol Hill meetings on draft MOU addressing certain distributions of compounded human drug products between states and the FDA; proposed changes to the 340B prescription drug program - oppose; 21st Century Cures Act (H.R.6) - support; proposed amendments to 340b program (not ultimately included in H.R.6) - oppose; provide comments on proposed 340b omnibus guidance (RIN 0906 AB08); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913)- support (with some concerns about pharmacy lock-in policy); submitted comments on Management Standards for Hazardous Waste Pharmaceuticals (EPA-HQ-RCRA-2007-0932); meeting with DEA on Controlled Substances Act (21 USC 802); proposed changes to regulation of Laboratory Developed Tests (FDA-2011-D-0360-Draft Guidance for Industry, Food and Drug Administration Staff and Clinical Laboratories: Framework for Regulatory Oversight of Laboratory Developed Tests) - oppose; Comprehensive Addiction and Recovery Act of 2016 ((S.524),monitoring for pharmacy lock-in policy, which includes exemption for LTC)- support; Increasing Competition in Pharmaceuticals Act (S.2615)- support.

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR).

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Medicare Part B and D Telemedicine Medicaid CHIP CHIP Re-authorization S.776 Medication Therapy Management Empowerment Act of 2015 HR 2624/S1488 Part D Beneficiary Appeals Fairness Act Part B proposal HR5122

Client expense: $75,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 776, Medication Therapy Management Empowerment Act of 2015. H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act. H.R. 793/S. 1190, Ensuring Seniors Access to Local Pharmacies Act of 2015. H.R. 244, MAC Transparency Act.

Client expense: $180,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to PBM's - no specific legislation Issues related to preferred pharmacy networks, mail order and incentives Issues related to prescription drug abuse, pharmacist provider status, drug pricing and drug supply chain safety. H.R.1600 - A bill to amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes. H.R.804 - Expanding the Availability of Medicare Data Act H.R.592 - Pharmacy and Medically Underserved Areas Enhancement Act S.314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R.244 - MAC Transparency Act H.R.1021 - Protecting the Integrity of Medicare Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R.471 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 S.483 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 Issues related to anti-PBM issues

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1270 - Restoring Access to Medication Act of 2015 S. 709 - Restoring Access to Medication Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R. 793 - Ensuring Seniors Access to Pharmacies Act of 2015 H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R.6 - 21st Century Cures Act S.1190 - Ensuring Seniors Access to Local Pharmacies Act of 2015 S. 1913 - Stopping Medication Abuse and Protecting Seniors Act of 2015 H.R.4878 - Better Care, Lower Cost Act S. 3094 - Price Relief, Innovation, and Competition for Essential Drugs Act HR 5573 - Price Relief, Innovation and Competition for Essential Drugs Act H. R. 4641 -To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes. HR 5210-Patient Access to Durable Medical Equipment Act S 2736-Patient Access to Durable Medical Equipment Act of 2016

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

All legislative and executive actions concerning healthcare reform, including provisions related to medication therapy management, pharmacy dispensing fees, drug safety, prescription drug diversion and abuse, drug shortages, supply chain, Medicare Sustainable Growth Rate, Medicaid reimbursement, provider status and any willing pharmacy. HR 793-Ensuring Senior Access to Local Pharmacies Act of 2015, HR 592-Pharmacy and Medically Underserved Areas Enhancement Act, S 314-Pharmacy and Medically Underserved Areas Enhancement Act, S 776-Medication Therapy Management Empowerment Act of 2015, FY-2016 National Defense Authorization Act, sections related to Tricare. HR 953-Comprehensive Addiction and Recovery Act of 2015, S 524-Comprehensive Addiction and Recovery Act of 2016.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Part B and D Telemedicine Medicaid CHIP CHIP Re-authorization S.776 Medication Therapy Management Empowerment Act of 2015 HR 2624/S1488 Part D Beneficiary Appeals Fairness Act FY 17 appropriations for HHS,CDC,NIH,DOD,FOA,VA H.R. 2029 FY16 omnibus Budget Control Act

Client expense: $308,850 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to prescription drug abuse, preferred pharmacy networks, pharmacist provider status, 340B, drug pricing and drug supply chain safety & Tricare. Issues related to biosimilars, FDA repackaging and drug disposal. HR 1600 :A bill to amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes. HR 592 - Pharmacy and Medically Underserved Areas Enhancement Act S 314 - Pharmacy and Medically Underserved Areas Enhancement Act HR 244 - MAC Transparency Act S 776 - Medication Therapy Management Empowerment Act of 2015 HR 471 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 S 483 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015 HR 1735-National Defense Authorization Act for Fiscal Year 2016 HR 6-Stopping Medication Abuse and Protecting Seniors Act of 2015 S 1913-Stopping Medication Abuse and Protecting Seniors Act of 2015 HR 1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S 480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015

Client expense: $1,460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services. H.R. 270 Flexibility in Health IT Reporting Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 - Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 - MAC Transparency Act (All provisions) H.R. 2507 - The Increasing Regulatory Fairness Act (All provisions) 2017 CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers S. 2484 - CONNECT for Health Act (All provisions) CMS/Medicare Advantage ESRD rate formulation

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

CMS regulations related to the treatment of Medicare Part C and Part D CMS regulations pertaining to reimbursement rates for ESRD-related services. H.R. 270 Flexibility in Health IT Reporting Act (All provisions) Comprehensive reforms to meaningful use; stage 3 meaningful use proposed rule S. 598 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) H.R. 1130 Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 (All provisions) S. 776 - Medication Therapy Management Empowerment Act of 2015 (All provisions) H.R. 244 - MAC Transparency Act (All provisions) H.R. 2507 - The Increasing Regulatory Fairness Act (All provisions) 2017 CMS regulations pertaining to reimbursement rates for ESRD-related services CMS survey and certification of kidney dialysis centers S. 2484 - CONNECT for Health Act (All provisions) CMS/Medicare Advantage ESRD rate formulation

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

H.R.471 & S. 483 legislation to prevent and reduce prescription drug abuse. H.R. 592 & S. 314, Provide for coverage under Medicare program of pharmacist services. Medication Therapy Management, including S. 776 The Medication Therapy Management Empowerment Act of 2015.

Client expense: $370,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 776, Medication Therapy Management Empowerment Act of 2015. H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act. H.R. 793/S. 1190, Ensuring Seniors Access to Local Pharmacies Act of 2015. H.R. 244, MAC Transparency Act.

Client expense: $240,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose.

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Reducing the costs of pharmaceuticals, medical devices, and supplies for consumers and health care providers, including implementation of the Drug Quality and Security Act (P.L.113-54) and P.L.112-144; support medical device pricing transparency and prohibition on medical device price "gag clauses"; preserving access to group purchasing organizations (GPOs) and protecting the GPO safe harbor; educating policymakers on hospital drug shortages and significant drug price increases and support draft reform legislation; pharmaceutical labeling of generic drugs (FDA-2013-N-0500); legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; support reforming the durable medical equipment competitive bidding program; supporting "any willing pharmacy" legislation; promoting access to biosimilars (labeling/interchangeability); 21st Century Cures Act (H.R.6) - general support for overall bill, support final pharmacy lock-in policy, oppose PPSA weakening of existing requirements, oppose Section 4004 treatment of infusion drugs furnished through durable medical equipment; Ensuring Seniors Access to Local Pharmacies Act (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Empowerment Act (S.776) - support; Strengthening Medicare Advantage Through Innovation and Transparency for Seniors - oppose; FDA-2014-D-1524-0002 - comments, Administration and Capitol Hill meetings on draft guidance on repackaging of certain human drug products by pharmacies and outsourcing facilities; FDA-2014-N-1459 - comments and Capitol Hill meetings on draft MOU addressing certain distributions of compounded human drug products between states and the FDA; proposed changes to the 340B prescription drug program - oppose; 21st Century Cures Act (H.R.6) - support; proposed amendments to 340b program (not ultimately included in H.R.6) - oppose; provide comments on proposed 340b omnibus guidance (RIN 0906 AB08); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913)- support (with some concerns about pharmacy lock-in policy); submitted comments on Management Standards for Hazardous Waste Pharmaceuticals (EPA-HQ-RCRA-2007-0932); meeting with DEA on Controlled Substances Act (21 USC 802); proposed changes to regulation of Laboratory Developed Tests (FDA-2011-D-0360-Draft Guidance for Industry, Food and Drug Administration Staff and Clinical Laboratories: Framework for Regulatory Oversight of Laboratory Developed Tests) - oppose.

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

S. 776 - Medication Therapy Empowerment Act of 2015; H.R. 1021 - Protecting the Management Integrity of Medicare Act of 2015; H.R. 1270 - Restoring Access to Medication Act of 2015; S. 709- Restoring Access to Medication Act of 2015; H.R. 2- Medicare Access and Chip Reauthorization Act of 2015; H.R. 793 - Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 1190 -Ensuring Seniors Access to Local Pharmacies Act of 2015; S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act;

Client expense: $410,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Personnel Management (OPM), SENATE

S. 314 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 - Pharmacy and Medically Underserved Areas Enhancement Act H.R. 1270 - Restoring Access to Medication Act of 2015 S. 709 - Restoring Access to Medication Act of 2015 S.776 - Medication Therapy Management Empowerment Act of 2015 H.R. 793 - Ensuring Seniors Access to Pharmacies Act of 2015 H.R. 1021, the Protecting the Integrity of Medicare Act (PIMA) of 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R.6 - 21st Century Cures Act S.1190 - Ensuring Seniors Access to Local Pharmacies Act of 2015 S. 1913 - Stopping Medication Abuse and Protecting Seniors Act of 2015

Client expense: $580,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

All legislative and executive actions concerning healthcare reform, including provisions related to medication therapy management, pharmacy dispensing fees, drug safety, prescription drug diversion and abuse, drug shortages, supply chain, Medicare Sustainable Growth Rate, Medicaid reimbursement, provider status and any willing pharmacy. HR 793-Ensuring Senior Access to Local Pharmacies Act of 2015, HR 592-Pharmacy and Medically Underserved Areas Enhancement Act, S 314-Pharmacy and Medically Underserved Areas Enhancement Act, S 776-Medication Therapy Management Empowerment Act of 2015, FY-2016 National Defense Authorization Act, sections related to Tricare. HR 953-Comprehensive Addiction and Recovery Act of 2015, S 524-Comprehensive Addiction and Recovery Act of 2016.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE