With increasing bipartisan focus on pharmacy benefit managers’ (PBM) tactics that harm patients and the pharmacies that serve them, the National Association of Chain Drug Stores (NACDS) is defining the solutions for comprehensive reform.
“We look forward to continuing to work with Congress to stop the manipulation by PBM go-betweens that increases patients’ medication costs, limits patients’ choice of pharmacies, and restricts access to medicines that are right for them,” wrote NACDS President and CEO Steven C. Anderson in a statement for today’s U.S. Senate Committee on Commerce, Science, & Transportation hearing, “Bringing Transparency and Accountability to Pharmacy Benefit Managers.”
NACDS detailed “policy recommendations to increase transparency and ensure comprehensive reform of harmful PBM practices”:
Help to Preserve Patient Access to Pharmacies by Addressing PBMs’ Retroactive Pharmacy Fees
Retroactive Direct and Indirect Remuneration Fees (DIR Fees)/Claw Backs – Policymakers should prohibit payers or PBMs from retroactively reducing and/or denying a processed pharmacy drug claim payment, and obligate them to offer predictable and transparent pharmacy reimbursement to better protect pharmacies as viable and reliable access points for care.
Provide Fair and Adequate Payment for Pharmacy Patient Care Services
Reasonable Reimbursement and Rate Floor – To help maintain robust public access to pharmacies, policymakers should adopt a reimbursement rate floor that requires PBMs to use comprehensive reimbursement models that are no less than the true cost to purchase and dispense prescription drugs.
Standardized Performance Measures – Policymakers should standardize PBMs’ performance measures for pharmacies to help set achievable goals for pharmacies before signing a contract, and to promote harmonization in the healthcare system and improvements in health outcomes.
Protect Patient Choice of Pharmacies
Specialty Pharmacy – Policymakers should establish appropriate standards for defining and categorizing specialty drugs to ensure comprehensive and pragmatic patient care and access. Policymakers should prohibit PBMs from steering patients to only specialty pharmacies, including those owned by the PBMs, for their prescription needs.
Mail Order – Policymakers should support patient choice and access by enacting laws to prohibit PBMs from requiring or steering patients to use mail-order pharmacies.
Any Willing Pharmacy – Policymakers should require PBMs and plans to include any pharmacies in their networks if the pharmacy is willing to accept the terms and conditions established by the PBM. This will help to maximize patient outcomes and cost savings.
Enforce Laws to Stop PBM Manipulation and Protect Pharmacies and Patients
Audits – Policymakers should support fair pharmacy audit practices to ensure timely patient care delivery at community pharmacies and bring efficiency, transparency, and standardization to the PBM audit process.
Oversight Authority – Policymakers should establish and enforce laws already on the books to regulate harmful PBM reimbursement practices that may harm patients and the healthcare system as we know it, especially at the pharmacy counter, and empower state regulators to do the same to enforce PBM transparency and fair and adequate pharmacy reimbursement.
More information about the implications of current “pharmaceutical benefit manipulation” is available in a 100-second explainer video and a two-page document by NACDS.
