The Federal Trade Commission’s (FTC) unanimous decision this week to examine pharmacy benefit manager (PBM) issues contributes to a growing wave of attention and action that stands to protect patients’ healthcare access and affordability and the viability of pharmacies of diverse sizes and formats.
The FTC stated strongly: “[PBMs] often have enormous influence on which drugs are prescribed to patients, which pharmacies patients can use, and how much patients ultimately pay at the pharmacy counter. Many of these functions depend on highly complicated, opaque contractual relationships that are difficult or impossible to understand for patients and independent businesses across the prescription drug system.”
As NACDS stated in comments to the FTC on February 15 and May 19, “The unregulated reimbursement practices of PBMs have caused numerous pharmacies to close, leaving many communities without front-line healthcare providers. Helping to ensure that PBMs’ reimbursement rates cover pharmacies’ costs of acquiring and dispensing prescription medications and associated services, and counseling, is a critical factor for preserving and protecting patient access to needed care and services provided by pharmacies.”
NACDS said in the May 19 response to the FTC’s request for comments about a potential investigation, “NACDS and its members have a strong interest in the PBM practices which are the subject of this solicitation, including PBM pharmacy contract terms, which impact all retail community pharmacies, including chains small and large, and, by extension, their patients.”
In our comments, NACDS described PBM practices that should be understood and acted upon as part of the FTC’s work to promote competition in the best interest of consumers and in fairness to market participants – including pharmacies which serve as the face of neighborhood healthcare.
Beyond the FTC’s announcement today, it is critical that decision-makers at the federal and state levels – in the legislative and executive branches – continue to deliver swift and practical action that is needed by patients and by pharmacies. Since the U.S. Supreme Court’s landmark decision in December 2020, consistent with an NACDS amicus brief, states have moved forward with crucial PBM reform legislation and regulatory action. This progress, and diligence in implementation and enforcement, must be sustained. In addition, following an important step forward by the federal Centers for Medicare & Medicaid Services in May 2022, significant work remains to bring about truly comprehensive reform of direct and indirect remuneration (DIR) fees imposed by payers on pharmacies.
Amid the complexities of these issues, it is imperative for federal and state decision-makers to remain focused on effective action that can positively impact patients and the pharmacies and pharmacy teams who serve them. NACDS will remain vigilant in advocating for bona fide pro-patient and pro-pharmacy solutions.
