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55 Matching News Items

1.  Community Pharmacists Respond to PCMA's Amicus Brief on States' Authority to Regulate PBMs
National Community Pharmacists Association [NCPA] Link to more items from this source
Mar. 25, 2020
"The PBMs have argued for decades that they are exempt from state regulation by vague language in [ERISA]. The law precludes states from regulating employee benefit plans, but not third-party vendors hired by the plans." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. granted Jan. 13, 2020)]
2.  Pharmacy Associations Join Forces to Advocate for Pharmacists During Change Healthcare Outage
National Community Pharmacists Association [NCPA] Link to more items from this source
Mar. 4, 2024
"Pharmacists and pharmacies are asking [PBM executives and other insurance payers] for assurances that claims fulfilled during this outage will be paid, and paid in a timely manner ... The pharmacy organizations also asked Change Healthcare to work with the appropriate partners to expeditiously implement less onerous means for all willing pharmacies to process impacted manufacturer patient assistance programs."
3.  Pharmacists Comment on CBO's Conclusion That Use of Prescription Drugs Can Reduce Health Care Costs
National Community Pharmacists Association [NCPA] Link to more items from this source
Dec. 3, 2012
"CBO's new analysis represents the tip of the iceberg in terms of the savings independent community pharmacists can produce for Medicare and other health plans. CBO examined only the quantity of prescriptions filled, not the qualitative benefits of strong patient-pharmacist relationships in helping patients take their medication appropriately. For years, private research has documented both patients' preference for their local community pharmacy as well as the cost-savings potential of face-to-face pharmacist-patient consultations to maximize the health benefits of prescription drugs."
4.  The Heat Is On, and Pharmacists are Thrilled. PBMs? Not So Much.
National Community Pharmacists Association [NCPA] Link to more items from this source
Mar. 13, 2023
"Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Accountability, announced that his committee has launched an investigation into PBMs and their business practices.... Comer is asking for a lot of information about discount cards, rebates, contracts, and more.... Pharmacists and patients have known ... for a long time that PBMs evolved their business model long ago to benefit from higher prescription drug prices.... But attempts to change the pharmacy payment model will be met with intense lobbying pressure."
5.  Pharmacists Commend Congress' Concern over Medicare Preferred Pharmacy Drug Plans
National Community Pharmacists Association [NCPA] Link to more items from this source
Mar. 21, 2013
"Thirty-one U.S. Representatives and a U.S. Senator have written to Medicare raising questions about the impact of so-called 'preferred pharmacy' drug plans, which may actually raise costs to the Medicare Part D program and taxpayers ... Most plans do not allow independently owned pharmacies to participate as a preferred pharmacy in their network. The increasing number of preferred pharmacy plans are especially challenging for seniors in rural areas, where independent or regional pharmacies are often the closest pharmacy and where the nearest preferred pharmacy may be 20 miles or more away."
6.  National Association of Insurance Commissioners Releases Draft PBM Model Legislation
National Community Pharmacists Association [NCPA] Link to more items from this source
July 6, 2020
"Although still a work in progress, the draft language would require PBMs to obtain a license from the state's insurance commissioner, permit the commissioner to adopt PBM regulations, and prohibit certain PBM abuses (such as retroactive payment reductions, spread pricing, and self-dealing)."
7.  National Association of Insurance Commissioners to Review Pharmacy Benefit Management in 2016
National Community Pharmacists Association [NCPA] Link to more items from this source
Nov. 24, 2015
"[T]he National Association of Insurance Commissioners (NAIC) ... 2016 work plan for its Health Insurance and Managed Care (B) Committee ... [includes] among other things, 'review and, if necessary, consider revisions to the Health Carrier Prescription Drug Benefit Management Model Act (#22) -- adopted in 2003 -- to address issues related to: [1] transparency, accuracy and disclosure regarding prescription drug formularies and formulary changes during a policy year; [2] accessibility of prescription drug benefits using a variety of pharmacy options; and [3] tiered prescription drug formularies and discriminatory benefit design.' ... [C]ommittee members indicated support for soliciting initial public comments from interested stakeholders in January, and to begin periodic conference calls in February to consider changes to the model."
8.  Pharmacy Organizations Blast Tenth Circuit Decision Invalidating an Oklahoma Law Regulating PBMs
National Community Pharmacists Association [NCPA] Link to more items from this source
Aug. 16, 2023
" 'The Tenth Circuit decision is inconsistent with what other federal courts have decided, and it seems to depart from the Supreme Court's unanimous Rutledge decision, which clearly held that PBMs can't hide behind ERISA. It must be overturned.' said B. Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA)."
9.  NCPA Blasts FTC for Failing to Investigate PBMs
National Community Pharmacists Association [NCPA] Link to more items from this source
Feb. 17, 2022
"After hearing hours of testimony by community pharmacists and patients, all of whom painted the same shocking picture about PBM abuse, and not a single witness there to defend the PBM industry, it is inexplicable that two members of the commission could vote against the study."
10.  NCPA Applauds Class Action Lawsuit Alleging Collusion Between Express Scripts and Other PBMs
National Community Pharmacists Association [NCPA] Link to more items from this source
Jan. 10, 2024
"The lawsuit ... claims that Express Scripts used its dominant market position to push rival PBMs to impose excessive back-end fees on pharmacies and then share the revenue with Express Scripts." [Osterhaus Pharmacy, Inc. v. Express Scripts Inc., No. 24-0039 (W.D. Wash. complaint filed Jan. 9, 2024)]
11.  NCPA Offers House Committee Suggestions to Enhance Medicare, Increase Access to Prescription Drugs
National Community Pharmacists Association [NCPA] Link to more items from this source
May 22, 2017
"NCPA recommended the following: [1] Enact H.R. 1038 (the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act). The legislation would ban retroactive direct and indirect remuneration (DIR) fees on community pharmacies. [2] Strengthen and finalize proposed CMS guidance on DIR and pharmacy price concessions. [3] Review and standardize how Part D plans measure pharmacy quality and performance in community pharmacies. [4] Enact H.R. 1316 (the Prescription Drug Price Transparency Act) to increase transparency into how generic drugs are priced by PBMs and paid for in Medicare."
12.  NCPA Statement for Senate Subcommittee Hearing: Ensuring Fairness and Transparency in the Market for Prescription Drugs (PDF)
National Community Pharmacists Association [NCPA] Link to more items from this source
May 5, 2022
"PBMs play an oversized role in federal health care programs as large corporate middlemen. The United States is the only country in the world that utilizes PBMs, and drug prices in this country remain exponentially higher compared to other countries. PBMs determine which pharmacies patients may choose by creating provider networks, determine which drugs patients can be prescribed by creating drug formularies, and determine how much patients pay at the pharmacy counter for their medications. Because of their anticompetitive practices and our nation's ever-increasing drug costs, greater scrutiny over PBM business tactics is imperative."
13.  NCPA Cites Litany of PBM Abuses at FTC Hearing
National Community Pharmacists Association [NCPA] Link to more items from this source
Feb. 17, 2022
"Huge claw-backs, patient steering, under-water reimbursements, mafia-style contracts. NCPA didn't pull any punches today at an FTC hearing on whether the agency should order PBMs to hand over reams of information about their anti-competitive practices."
14.  NCPA to FTC: Investigate and Fix Anticompetitive PBM Contracting
National Community Pharmacists Association [NCPA] Link to more items from this source
Sept. 27, 2021
"The joining together of the major commercial health plans with PBMs and with consumer pharmacy operations created vertical entities wielding multi-market power unlike any since the railroad and oil monopolies that spawned antitrust laws.... Often, after thrashing small business pharmacies via low and below-cost reimbursement, the health plan-PBM-retail pharmacy conglomerate will offer to buy out and shutter the harmed pharmacy, adding to their portfolio of corporate owned pharmacies, which further consolidates the health care marketplace."
15.  NCPA Urges West Virginia to Include Fair Reimbursement, Full Enforcement in PBM Reform Rules
National Community Pharmacists Association [NCPA] Link to more items from this source
July 8, 2021
"NCPA is urging the state to specify that pharmacy reimbursement should be inclusive of all fees, clawbacks, etc. that a PBM charges a pharmacy and that net reimbursement cannot be lower than the acquisition cost and required dispensing fee."
16.  NCPA Supports NAIC Plan to Adopt Model PBM Oversight Legislation
National Community Pharmacists Association [NCPA] Link to more items from this source
June 24, 2021
"[T]he model bill would require PBMs to obtain a license from the state's insurance commissioner, permit the commissioner to adopt PBM regulations, and prohibit certain PBM abuses such as retaliating against a pharmacy for discussing PBM compliance issues with the insurance commissioner."
17.  NCPA Comments to FTC Shine Spotlight on PBMs
National Community Pharmacists Association [NCPA] Link to more items from this source
Dec. 10, 2017
"NCPA's ... policy recommendations ... include: [1] Support for the [DOL's] recommendation to require PBMs to disclose all direct and indirect compensation to ERISA plans, to evaluate whether compensation to PBMs, pharmacies (including those owned by PBMs) and subcontractors are 'reasonable.' [2] Collaboration with DOL to create a standardized definition of what constitutes 'brand,' 'generic,' 'specialty,' and 'rebate' for the purposes of eliminating confusion in ERISA drug plan designs. [3] Endorsement of federal and state transparency efforts surrounding PBM 'maximum allowable cost' lists for generic prescription drugs. [4] Increased scrutiny of the conflicts of interest that can be attributed to PBMs operating as both a reimburser and competitor in the pharmacy marketplace."
18.  NCPA Statement for House HELP Committee Hearing on the Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay (PDF)
National Community Pharmacists Association [NCPA] Link to more items from this source
Oct. 17, 2017
"PBMs serve as the 'middlemen' in most prescription drug transactions in the United States. First, they leverage the number of beneficiaries in a plan to negotiate lucrative rebates from pharmaceutical manufacturers. Second, they formulate limited pharmacy provider networks that will supply or dispense these drugs to plans' beneficiaries and in turn, charge plan sponsors for these products.... PBMs extract 'spread' profits from both activities. Unless a plan has negotiated a true 'pass through' contract with its PBM -- and typically only the largest and most sophisticated plans are able to do so -- the PBM will keep a significant percentage of the rebate dollars that they have obtained only by virtue of the number of the plans' beneficiaries for themselves."
19.  NCPA Statement to the Senate HELP Committee on the Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay (PDF)
National Community Pharmacists Association [NCPA] Link to more items from this source
June 13, 2017
"Since their inception, PBMs have morphed from claims adjudicators into little known and largely unregulated corporate giants that exploit their strategic position at the 'middle' of nearly all drug transactions in the U.S. to extract profits from the upstream and downstream participants in the drug supply chain while providing questionable value to the ultimate consumer. PBMs are also heavily involved in and reap enormous profits from their involvement in federally supported or subsidized health care programs, like Medicare and Medicaid."
20.  NCPA, IPA File Brief in Federal Appeals Court in PBMs' Case Against Iowa Drug Pricing Transparency Law
National Community Pharmacists Association [NCPA] Link to more items from this source
Feb. 4, 2016
"The amicus curiae brief submitted by NCPA and IPA supports the lower court's decision and puts forth compelling legal reasons why Iowa's law is not preempted by ERISA or is unconstitutional under the so-called dormant Commerce Clause of the Constitution as PCMA has alleged. We hope the Eighth Circuit rejects PCMA's desperate attempt to invalidate the legality of the drug price transparency law."
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