NCPA Offers Help as Senate Committee Mulls PBMs' Role in Rising Prescription Drug Prices
ALEXANDRIA, Va. (Jan. 23, 2017) The National Community Pharmacists Association (NCPA) sent a letter to the U.S. Senate Special Committee on Aging in response to its recent report entitled "Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model that Harms Patients, Taxpayers, and the U.S. Health Care System".
NCPA's letter responds to a passage in the report related to pharmacy benefit managers (PBMs) stating "another area worthy of further study is the role of PBMs. While some experts claim that PBMs function to keep down the price of drugs, other have suggested that PBMs may be contributing to part of the drug pricing problem. The Committee does not have visibility into this area from its investigation due to the fact that PBMs played a limited role in the drugs investigated by the Committee."
NCPA's letter notes PBMs exert enormous influence on health care costs by deciding "what medications are covered by the plan (the formulary), what pharmacies are in the network, what the consumer will pay, what the plan sponsor will be charged, and what the pharmacy will be paid. They also negotiate rebate arrangements with drug manufacturers in exchange for including medications on the formulary."
The letter raises concerns about the lack of oversight of PBMs underscoring 2014 testimony before the Department of Labor ERISA Advisory Council "that the lack of PBM transparency makes it difficult to determine whether PBMs are providing appropriate value. Additionally, in 2009, OPM Inspector General Patrick McFarland highlighted the need for greater PBM oversight as it pertains to federal employee health benefit plans in testimony before the House Oversight and Government Reform Committee."
The letter urges the Senate Aging Committee to initiate an investigation of PBMs to provide "committee members and Congress as a whole with a comprehensive view of the causes of higher drug prices and to develop policies that properly address them." NCPA also offers to share the unique insights its member independent community pharmacies have to aid any investigative efforts.