NCPA Supports Congressional Move for Transparency in Generic Drug Payments
11 U.S. House representatives sent a letter to the Centers for Medicare and Medicaid Services requesting information about the enforcement of transparency measures for 2016 Medicare Part D plans.
ALEXANDRIA, Va. (July 9, 2015) —
Eleven members of the U.S. House of Representatives have sent a
to the Centers for Medicare and Medicaid Services (CMS) requesting information about the enforcement of transparency measures governing generic prescription drug payments in Medicare Part D plans for 2016.
Transparency provisions for maximum allow costs or MAC pricing were included by CMS in its
issued in May 2014, but the regulatory framework that will determine the implementation of such provisions has not been released. Reps. Rick Allen (R-Ga.), Rod Blum (R-Iowa), Buddy Carter (R-Ga.), Doug Collins (R-Ga.), Morgan Griffith (R-Va.), Walter Jones (R-N.C.), Dave Loebsack (D-Iowa), John Sarbanes (D-Md.), Austin Scott (R-Ga.), Peter Welch (D-Vt.) and Lynn Westmoreland (R-Ga.) signed the letter calling for more details on how the transparency provisions will be enforced.
The letter also points out the fundamental reason why reimbursement issues must be addressed: “Generic prescription drugs account for over 80 percent of drugs dispensed, but details surrounding the reimbursement system for these medications is unknown to pharmacists and raises serious questions as to whether Medicare is overpaying the plan drug middlemen.” The letter goes on to explain that there is a need for oversight: “As you begin preparing to enforce these provisions please share with us your plans to ensure ordered implementation. Many states have passed MAC Transparency laws and have struggled to enforce them effectively.”
The letter also highlights a robust MAC reform bill pending in the U.S. House of Representatives --
— introduced by Reps. Collins and Loebsack as a possible framework for additional measures that can be implemented for greater fairness in generic drug pricing and transparency.
In response B. Douglas Hoey, RPh, MBA, the
CEO, issued the following statement:
“Independent community pharmacies have struggled to remain financially viable due to the discrepancy between the soaring acquisition costs for many generic prescription drugs and the outdated and low reimbursements they receive from pharmacy benefit manager (PBM) corporations. That’s why we were heartened when CMS made a commitment to not only ensure generic drug reimbursements are updated by PBM corporations on a weekly basis to reflect market prices, but also to provide information as to how those reimbursements are determined for Medicare Part D next year.
“Needed guidance from CMS that will determine how PBM corporations must follow these new requirements is still pending, which is why a bipartisan coalition from the U.S. House of Representatives took the opportunity to remind CMS why this change is badly needed. NCPA appreciates their support, because the unfortunate ‘buy high-sell low’ dynamic is not sustainable. But most importantly, by creating a fairer reimbursement system, independent community pharmacies can focus more on what they do best — serve patients.”