NCPA Focuses on PBMs' Role in High Prescription Drug Prices as White House Prepares to Act

ALEXANDRIA, Va. (June 29, 2017) — Pharmacy benefit managers (PBMs) have a business model that contributes to rising prescription drug prices, the National Community Pharmacists Association (NCPA) asserts in a letter to U.S. Office of Management and Budget Director Mick Mulvaney.

In the letter, NCPA requested a meeting and offered recommendations for reforming PBMs as the Trump Administration considers steps to tackle rising prescription drug costs.

"We all agree on the need to ensure prescription drug access and affordability," the letter states. "However, this issue cannot be solved without addressing the role of PBMs in increasing costs. As the PBM role has expanded to include negotiating with manufacturers, contracting with and paying pharmacies and administering plans and billing plan sponsors, they have grown into oversized players and that position requires enhanced scrutiny."

NCPA's remedy for addressing some of the more controversial PBM business practices include:

  • Having the Centers for Medicare and Medicaid Services (CMS) fix unpredictable retroactive pharmacy direct and indirect remuneration (DIR) fees that cause Medicare beneficiaries and taxpayers to pay more for prescription drugs.
  • Pushing for policies promoting pharmacy competition and patient choice that are being undermined by the conflicts of interest associated with PBMs' ownership of mail order and specialty pharmacies.
  • Addressing the lack of transparency and added cost resulting from PBMs providing preferential treatment on their formularies that determine which prescription drugs get dispensed because of drug manufacturer rebate deals.

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