The National Community Pharmacists Association sent a letter to the Centers for Medicare & Medicaid Services responding to the agency’s request for information as it begins drafting rules to implement the recently passed pharmacy benefit manager reform, according to a July 23 statement.
NCPA CEO B. Douglas Hoey said, “The rulemaking process is critical because that’s where the rubber meets the road. CMS is writing the rules that will implement what Congress intended when it passed PBM reform. We know the PBMs will try to have loopholes inserted into the rules, so we are working with CMS to ensure the rules are clear and tight.”
CMS requested comments from interested parties regarding PBM compensation under the new law. In its response, NCPA addressed three main questions: defining what constitutes a PBM or PBM affiliate, determining how PBMs should be compensated, and establishing reimbursement methods for independent community and long-term care pharmacies.
According to NCPA, a pharmacy benefit manager should be defined by its actions rather than corporate language in order to prevent regulatory avoidance through subsidiaries or affiliates performing similar services. The association also supports compensating PBMs in Medicare Part D through a straightforward administrative fee rather than rebates from drugmakers or tying payment to drug list prices.
NCPA urged CMS to require that independent pharmacies be reimbursed based on their actual cost of acquiring drugs plus an objective dispensing fee and payment for professional services provided by pharmacists. Current reimbursement practices are determined by criteria set by PBMs themselves.
Hoey said, “This is a chance to restore PBMs to their original purpose, which is to help make the prescription payments easier for employers, unions, and patients... But vertical integration has allowed them to grow into monopolies with massive power. As their market share has grown through consolidation and by suffocating smaller competitors, they’ve abused their market power to increase their profits at the expense of taxpayers, employers, and health care providers.”
CMS plans additional requests for information during this process related specifically to contract terms mandated by Congress. Hoey concluded, “We look forward to working with CMS as this process advances, and we are grateful for the opportunity to comment during this initial stage.”
Founded in 1898, NCPA represents over 18,900 pharmacies employing more than 235,000 individuals nationwide.
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