NCPA led its other partners in the Pharmacy Coalition (formerly known as the “Reasonable and Relevant Coalition”) in submitting a memo via consulting firm Leavitt Partners to CMS leadership, calling on the agency to further regulate standards governing “reasonable and relevant” pharmacy contract terms and conditions under Medicare Part D’s any willing pharmacy requirements.
The Pharmacy Coalition consists of NCPA, the American Pharmacists Association, the National Association of Chain Drug Stores, the American Society of Consultant Pharmacists, the National Association of Specialty Pharmacy, and FMI – The Food Industry Association.
The new PBM law directs the Secretary of Health and Human Services to establish standards for “reasonable and relevant” contract terms and conditions under Medicare Part D’s any willing pharmacy provisions. Congress included a “notwithstanding any other provision of law” clause to ensure that this authority operates without limitation from other potentially conflicting statutory language, including the Part D noninterference clause.
The memo argues that CMS has clear statutory authority to establish standards for “reasonable and relevant” contract terms and that CMS has a long history of regulating contracting-related matters under Part D, including pharmacy network adequacy, preferred cost sharing, credentialing, direct and indirect remuneration, and retail access.
