In a letter to the Centers for Medicare & Medicaid Services sent last week, NCPA urged the agency to ensure PBMs can’t circumvent new reforms by hiring their own subsidiaries or affiliates to perform what are essentially PBM services. We argued PBMs should be paid through a simple administrative fee untethered from drugmaker rebates or list prices of drugs. NCPA also asked CMS to require PBMs to reimburse independent community and LTC pharmacies for the cost of acquiring the drug, plus a dispensing fee and a fee for pharmacist-provided professional services.
The letter was sent in response to a request for information from CMS as it begins writing rules implementing landmark PBM reforms in Medicare Part D that were passed earlier this year.
“This is a chance to restore PBMs to their original purpose, which is to help make the prescription payments easier for employers, unions, and patients,” said NCPA CEO Douglas Hoey. “They were never intended to control every aspect of patient care, including overruling the medical decisions of doctors and pharmacists. But vertical integration has allowed them to grow into monopolies with massive power. As their market share has grown through consolidation and by suffocating smaller competitors, they’ve abused their market power to increase their profits at the expense of taxpayers, employers, and health care providers.”
You can read our full press release here, and our letter to CMS here.
