ALEXANDRIA, Va. (June 13, 2017) In comments submitted for the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee's hearing, "The Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay," the National Community Pharmacists Association (NCPA) directed the committee's attention to the role pharmacy benefit managers (PBMs) continue to play in escalating drug costs.
"The overly concentrated and largely unregulated PBM industry exerts immense influence over how prescription drugs are accessed by the majority of Americans," NCPA wrote. "Given the fact that the federal government is the largest single payer of health care in the United States, it makes financial sense for Congress to demand increased transparency into this aspect of the prescription drug marketplace in order to identify potential savings."
NCPA's comments identified areas where the lack of transparency in the PBM business model adds cost for patients, health plan sponsors and pharmacies. The practices where those concerns are most prevalent are the profits the drug middlemen collect from drug manufacturers and pharmacies that are not fully shared with health plan sponsors; the nonexistent insight PBMs provide to pharmacies for the reimbursements they receive for generic prescription drugs; and the retroactive clawbacks the middlemen take well after the point of sale from pharmacies in the form of direct and indirect remuneration (DIR) fees.
NCPA's comments encouraged Congress to push for greater transparency and accountability for PBMs to help reduce prescription drug prices by passing S. 413 / H.R 1038, The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act. The companion bills would end DIR fees on community pharmacies, which Medicare concluded result in increased patient out-of-pocket costs and higher catastrophic costs to the government in Medicare Part D.