Independent Drugstore Lobby Seeks to Reduce PBM Control of Medicare Market

The independent drugstore lobby wants to get rid of mandates that give pharmacy benefit managers more control in the Medicare market.

The Pharmaceutical Care Management Association (PCMA) is currently promoting a national campaign called That’s What PBMs Do. The campaign highlights how pharmacy benefit managers (PBM) reduce drug costs and improve benefits for consumers, employers, unions, and government, according to a PCMA press release.

This campaign is occurring while the independent drug store lobby is pushing a plan that could potentially increase costs and reduce access for Medicare enrollees.

"PBMs will save consumers, employers, unions, and government programs $654 billion over the next decade," said PCMA President and CEO Mark Merritt. "Unfortunately, the independent drugstore lobby agenda would raise costs for seniors, employers, and programs like Medicare Part D."

PBMs reduce costs by offering home delivery of medications, creating discounts, promoting generics and less expensive brands, negotiating price concessions from drugmakers and drug stores, and managing high-cost medications, according to the release.

However, the independent drugstore lobby is attempting to get Congress to pursue “Any Willing Pharmacy” mandates to get rid of preferred pharmacy plans in Medicare. Their agenda would increase spending by $21 billion over a period of 10 years, according to the PCMA.

The article reported that 75% of Medicare enrollees chose preferred pharmacy plans. Another mandate would stop the use of Maximum Allowable Cost (MAC) lists that keep payers from overpaying for generic drugs. Currently, 45 states use MAC lists.

The lobby is also against programs such as Safe Pharmacy or Lock-In, which require at-risk Medicare enrollees to choose a single pharmacy for their prescriptions of controlled substances.

The PCMA said that although the independent drugstore lobby wishes to do away with these programs likely to include themselves in the market, a recent report from the 2015 National Community Pharmacists Association Digest said that the number of independent pharmacies is not declining and there is a stable profit margin for these companies.