NACDS is commending U.S. Senate Finance Committee Chair Ron Wyden (D-OR) for calling on the Centers for Medicare & Medicaid Services (CMS) “to step up oversight and enforcement of Medicare Part D program requirements for pharmacy benefit managers (PBM)” — so that patients may continue to benefit from the essential services provided by their pharmacies.
A June 24 letter from Sen. Wyden outlines several actions that CMS should immediately take to “protect pharmacies from unfair contracting practices”:
- Enforce “Any Willing Pharmacy” requirements by ensuring that PBMs reimburse pharmacies at a minimum of the cost to acquire and dispense covered prescription drugs.
- Enforce, such as through auditing, the pharmacy price concessions provision included in the Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency; Additional Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency final rule that requires all pharmacy price concessions be applied to negotiated prices at the point of sale under Part D.
- Implement standardized pharmacy measures which are long overdue, including the evaluation and reporting of plan performance measures which CMS has finalized in rulemaking yet has not fully come to fruition.
- Review formal or informal complaints about PBM contracting practices under Part D received over the past 18 months to determine if the number of complaints is higher than in prior years.
- Respond to this letter with information, within 60 days, on the number of formal or informal complaints received about PBM contracting practices over the past 18 months, a description of the type of complaints received, and the disposition of the complaints.
NACDS President and CEO Steven C. Anderson said of the news: “The inflated drug prices that Americans pay, the barriers to pharmacy and medication access that they face, and the impossible terms forced on pharmacies – at the hands of the pharmaceutical middlemen – cannot be allowed to stand. We applaud Senate Finance Committee Chair Ron Wyden for his ongoing commitment to delivering PBM reform. We urge CMS to act on the recommendations outlined by Senator Wyden that would help rein in PBMs and their harmful tactics – recommendations that the agency can implement within its existing authorities.
“An all-branches-of-government approach is what is critically needed to get PBM reform done.
“NACDS hails the bipartisan work of the Senate Finance Committee; the House Energy and Commerce Committee; the Senate Health, Education, Labor and Pensions Committee; the House Ways and Means Committee; the House Oversight and Accountability Committee; the Senate and House leadership; and other leaders who continue work toward the enactment of comprehensive PBM reform — on which Congress has achieved broad and bipartisan consensus.
“For patients and for the pharmacies on which rely they, PBM reform is must-pass legislation in the 118th Congress.”
