NCPA continues to be a leading advocate for greater transparency from pharmacy benefit managers (PBMs), and renewed that call in written comments submitted recently to Medicare officials.
The U.S. Centers for Medicare & Medicaid Services (CMS) recently solicited comments regarding its proposed regulation to govern how Medicare Advantage and Medicare Part D prescription drug plans calculate their “medical loss ratios”, which essentially attempt to separate legitimate health care expenses from overhead and profit. NCPA seized on the opportunity to reinforce the need for plans to have greater insight into PBM revenue streams and to ensure that PBMs pay pharmacies fairly for their services.
The rule CMS is attempting to finalize comes as a direct result of provisions included in the Affordable Care Act (or Obamacare).
Mainly, NCPA’s comments sought to reinforce and strengthen provisions Medicare included in its proposed regulation to achieve greater PBM transparency for health plans. Specifically, NCPA urged CMS to:
- Retain aspects of its regulation which reject arguments by PBM industry representatives
- Clarify its treatment of prescription drug rebates to prevent potential PBM profiteering in this area
- Require PBMs to disclose to plans, for each transaction, the difference between what the plan pays the PBM and what the PBM pays the pharmacy
- Consider required medication therapy management services to be a health care activity, not an administrative one
This rule could have a profound impact on the delivery of health care services and give CMS and enrollees a clearer picture as to where their payments and premium dollars are going. NCPA applauds the agency for supporting enhanced transparency between plan sponsors and PBMs so that plans can better avoid overpaying PBMs for administrative services while at the same time avoid underpaying pharmacists caring for patients.