PBM Transparency, DIR Fees Top Priorities for Pharmacists on Capitol Hill


Community pharmacists urge Congress to support 3 priority bills that create transparency for pharmacy benefit managers and improve patient access.

The practices of pharmacy benefit managers (PBMs) and direct and indirect remuneration (DIR) fees continue to spark controversy in the pharmacy space, as many stakeholders are calling on lawmakers for more regulation.

This week on Capitol Hill, community pharmacists and pharmacy associations continue to press Congress to support 3 legislative priorities for independent community pharmacies, according to a National Community Pharmacists Association (NCPA) press release.

The bills are aimed at creating greater transparency for PBMs and expanding pharmacy access and choice for seniors, according to the press release. Other key issues to be addressed include provider status under Medicare Part B, compounding regulations, and recommendations for curbing the opioid epidemic.

According to the press release, the 3 priority bills are:

1. “The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act” (S413/HR 1038): Would end retroactive pharmacy DIR fees that push Medicare patients more quickly into the Part D coverage “donut hole.”

2. “The Ensuring Seniors Access to Local Pharmacies Act” (S1044/HR 1939): Would expand pharmacy choice for Medicare beneficiaries seeking discounted co-pays in preferred plans.

3. “The Prescription Drug Price Transparency Act” (HR 1316): Would create more transparency for generic prescription drug pricing and reimbursement in federal health.

NCPA and 46 state pharmacy groups sent a letter urging the US Senate Judiciary Committee to hold a hearing regarding the practices of PBMs.

The letter states, “Recently 2 of the big 3 PBMs announced acquisition plans with large insurers (CVS Health to acquire Aetna Inc. for $69 billion; Cigna to acquire Express Scripts for $67 billion). If these acquisitions proceed, all 3 of the largest PBMs will be vertically integrated with an insurance company, since UnitedHealth Group Inc. currently owns OptumRx. The potential harm from such continued market concentration should be closely examined.”

The Pharmaceutical Care Management Association (PCMA) released a statement emphasizing concerns about the proposed mandates.

“The independent drugstore lobby’s agenda is proven to raise costs and increase the deficit,” PCMA President and CEO Mark Merritt said in the press release. According to the PCMA, proposals requiring point-of-sale DIR fees in Medicare Part D would increase drugstore profits, raise premiums for beneficiaries, and increase costs for taxpayers.

However, pharmacists say PBM market concentration disadvantages both pharmacists and patients.

“The public is figuring out that prescription drug discounts are staying with the PBMs and not being passed down to the people who need them the most,” B Douglas Hoey, MBA, NCPA chief executive officer, said in a press release. “They’re seeing that PBMs are often paying themselves considerably more than they’re reimbursing community pharmacies. They’re even seeing patients charged more at the pharmacy counter than the net pharmacy reimbursement for the medication, and PBMs are pocketing the difference.”

This week’s conversations with members of Congress will highlight pending legislations that can address a range of PBM practices that harm patients, pharmacies, and taxpayers, Hoey added.


NCPA Press Congress to Support Pro-Patient, Pro-Pharmacy Agenda [news release]. Alexandria. NCPA’s website. http://www.ncpanet.org/newsroom/news-releases/2018/04/10/ncpa-presses-congress-to-support-pro-patient-pro-pharmacy-agenda. Accessed April 11, 2018.

Pharmacy Associations Urge Senate Judiciary Committee to Hold Hearing on PBMs [news release]. Alexandria. NCPA’s website. https://www.ncpanet.org/newsroom/news-releases/2018/04/09/pharmacy-associations-urge-senate-judiciary-committee-to-hold-hearing-on-pbms. Accessed April 11, 2018.

Drugstore Lobby Agenda Raises Government Costs, Increases Deficits [news release]. Washington, DC. PCMA’s website. https://www.pcmanet.org/drugstore-lobby-agenda-raises-government-costs-increases-deficit/. Accessed April 11, 2018.

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