Pharmacy Advocates Call for PBM Reform


The influence of pharmacy benefit managers in drug pricing was discussed during a Federal Trade Commission workshop.

The National Community Pharmacy Association (NCPA) continued to push for pharmacy benefit manager (PBMs) reform during a Federal Trade Commission (FTC) workshop, according to a press release.

The workshop included multiple panels that discussed how each supply chain component can raise the cost of prescription drugs. The NCPA spoke during a panel dedicated to PBMs.

"I commend the FTC for bringing health care industry officials together to discuss the pharmaceutical supply chain's strengths and weaknesses. It's timely as the government ponders the best course of action going forward," said NCPA CEO B. Douglas Hoey, RPh, MBA.

During the panel, the NCPA pointed out multiple issues with the current supply chain that can raise drug costs.

PBMs have been heavily scrutinized over a perceived lack of transparency in the past. During the workshop, the NCPA said that a lack of PBM transparency prevents plan sponsors and patients from being fully informed about their prescription drug benefits, according to the release.

Additionally, the organization said that there are 3 big PBMs that control virtually all of the market, which leaves little room for competition and lower prices.

Lastly, many PBMs also operate their own pharmacies, which the NCPA said is a conflict of interest because PBMs are in competition with the pharmacies they contract with. PBMs may be incentivized to develop plans that sway patients towards their own pharmacies, according to the NCPA.

"Independent community pharmacists have for years been sounding the alarm about the virtually unregulated PBM industry,” Hoey said. “Until that business model is fixed, the system for dispensing prescription drugs is going to be fundamentally flawed and costs will likely continue to rise."

Previously, the NCPA told Specialty Pharmacy Times that the PBM practice of direct and indirect remuneration fees that are charged retroactively to independent pharmacies threatens their viability and puts patients at risk of losing access to therapy.

During the session, the NCPA also discussed how employers and policymakers are considering reforming PBMs.

The potential action that tops the list is passing legislation that would increase transparency to ensure that PBMs are operating with patient cost savings in mind, according to the NCPA.

Additionally, the NCPA said that aligning incentives for stakeholders would prevent unnecessary costs. Better alignment of prescription drug and medical spending would also help increase medication adherence while preventing costly adverse events, according to the release.

The NCPA said that outcomes-based payments and alternative payment models would likely drive down prescription drug costs for patients.

Notably, the NCPA said that if health insurers and plan sponsors were to negotiate directly with manufacturers and remove PBMs from the process, this could reduce drug costs, according to the release.

"Whether it is the private or public sector, there needs to be a greater emphasis on ensuring the prescription drug supply chain maximizes efficiencies and rewards successful strategies for achieving better health outcomes,” Hoey said.

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