News Wire

Wyden “C-Thru” Bill Helps Pull Back Curtain on Duplicitous PBM “Rebates,” Suspect Pricing Schemes, Related Anti-Competitive Behavior

Noting a torrent of bipartisan legislation recently introduced requiring Pharmacy Benefit Manager (PBM) drug middlemen to pull back the curtain on veiled, opaque pharmaceutical pricing practices, the Senior Care Pharmacy Coalition (SCPC) today backed Sen. Ron Wyden’s (D-OR) “Creating Transparency to Have Drug Rebates Unlocked Act” (C-THRU) bill. The legislation requires PBMs — for the first time — to publicly disclose data regarding “rebates,” “discounts” and other accrued payments — and their impact on Medicare Part D beneficiaries and the Part D program overall.

“PBMs are under heavy scrutiny on both sides of the aisle due to their stubborn, blanket and unjustifiable resistance to transparency — and SCPC strongly supports Senator Wyden’s ‘C-THRU’ bill as a way to lift the veil of secrecy surrounding PBM behaviors that result in higher costs to consumers and lower savings for the Medicare program,” said Alan G. Rosenbloom, President and CEO of SCPC, which advocates for the nation’s long term care (LTC) pharmacies.

Continued Rosenbloom, “Senator Wyden is precisely correct in his observation that ‘the public knows virtually nothing about whether PBMs are saving money for the consumer or pocketing it themselves’.” The SCPC President and CEO pointed to a damaging January 2017 Centers for Medicare & Medicaid Services (CMS) report finding that drug companies, wholesalers and pharmacies are paying larger rebates and hidden fees to PBMs and insurers — but that PBMs are keeping the money rather than translating it into lower costs for beneficiaries or government health care programs.

Read the story here

Bill to help small pharmacies passes state senate

A bill sponsored by Sen. Steve Neville, R-Farmington, aims to help small pharmacies by eliminating fees they currently pay to middlemen.

“The small pharmacies around the state are having a hard time surviving,” Neville said when reached by phone today.

Neville worked with the New Mexico Pharmacy Business Council to draft the bill, which would prohibit pharmacy benefits managers from charging the pharmacies fees for claim processing and adjudication. Pharmacy benefits manager are third-party middlemen of prescription drug programs. These middle men check patient eligibility, administer plan benefits and negotiate costs between the pharmacies and the insurers. Each insurance company contracts with a pharmacy benefits manager.

Read the story here

An End to PBM Pick-Pocketing

Usually when your pocket has been picked, you discover the loss pretty quickly. But many of America’s more than 22,000 independent community pharmacies are finding their reimbursements for prescription drugs reduced well after the patient hands over the co-pay and leaves with their medicine. The technical term for this transaction is a “retroactive pharmacy direct and indirect remuneration (DIR) fee.” That’s one way of putting it.

DIR fees pick the pockets of community pharmacies and their patients.

Pharmacies dispense medication and are reimbursed, only to have a portion of that reimbursement then “clawed back” by pharmacy benefit managers weeks or months after the transaction. There’s often no way to anticipate the fees, and pharmacists are seldom provided sufficient justification for the clawback.

Read the story here

Middlemen’s Secret Drug Rebates Targeted by Wyden’s Bill

Senator Ron Wyden proposed legislation that would force drug middlemen to disclose secret discounts they receive from manufacturers, a sign of growing scrutiny of the role played by pharmacy benefit managers in high prices.

The bill would require pharmacy benefit managers such as Express Scripts Holding Co. and CVS Health Corp. to reveal the aggregate rebates that they receive from drug companies for Medicare plans and post the amounts on a government website, according to a statement from the Oregon Democrat’s office. While it may not pass in a Republican Congress, the proposal calls further attention to PBMs while drug prices are in the crosshairs of Washington lawmakers and President Donald Trump.

Read the story here

Drug Costs Too High? Fire the Middleman

A decade ago, Caterpillar Inc. looked at its employee drug plan and sensed that money was evaporating. The bills for pills had increased inexorably, so the company started to rein in its pharmacy benefit manager, or PBM. The managers are middlemen with murky incentives behind their decisions about which drugs to cover, where they’re sold, and for how much.

 In a decade when the average American’s drug spending has spiraled higher, the figure has fallen at the company. By hiring its own doctors and pharmacists, among other changes, Caterpillar has saved tens of millions of dollars a year. “The model is as successful today as it’s ever been,” says Todd Bisping, a global benefits manager at the company.

Read the story here