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Community Pharmacists Respond to PCMA's Amicus Brief on States' Authority to Regulate PBMs

"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)]

Pharmacy Associations Join Forces to Advocate for Pharmacists During Change Healthcare Outage

"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."

Pharmacists Comment on CBO's Conclusion That Use of Prescription Drugs Can Reduce Health Care Costs

"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."

The Heat Is On, and Pharmacists are Thrilled. PBMs? Not So Much.

"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."

Pharmacists Commend Congress' Concern over Medicare Preferred Pharmacy Drug Plans

"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."

National Association of Insurance Commissioners Releases Draft PBM Model Legislation

"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)."

National Association of Insurance Commissioners to Review Pharmacy Benefit Management in 2016

"[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."

Pharmacy Organizations Blast Tenth Circuit Decision Invalidating an Oklahoma Law Regulating PBMs

" '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)."

NCPA Blasts FTC for Failing to Investigate PBMs

"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."

NCPA Offers House Committee Suggestions to Enhance Medicare, Increase Access to Prescription Drugs

"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."