NACDS RxIMPACT Day on Capitol Hill Begins with Praise for Newly Introduced Legislation to Rein in Unfair PBM Audit, Reimbursement Practices
3/21/2012 10:06 AM
In anticipation of hundreds of meetings between pharmacy advocates and Members of Congress and their staff as part of NACDS RxIMPACT Day on Capitol Hill, the National Association of Chain Drug Stores (NACDS) sent a letter to U.S. Representative Cathy McMorris Rodgers (R-WA) applauding the introduction of her legislation yesterday that would establish Medicare standards for pharmacy audits and reimbursement by pharmacy benefit managers (PBM), who often use opaque methods and unfair tactics that threaten access to community pharmacy-provided services.
The bill was introduced as hundreds of pharmacy advocates fly to Washington, D.C. for more than 300 meetings with lawmakers and their staff to discuss opportunities to further leverage neighborhood pharmacy to advance patient health, reduce costs and spur the local economy.
Pharmacy advocates – including NACDS members, pharmacists, pharmacy students and chain pharmacy leaders – have already begun converging in the nation’s capital for the fourth annual NACDS RxIMPACT Day on Capitol Hill, held March 21 and 22.
The new legislation, the Medicare Pharmacy Transparency and Fair Auditing Act (H.R. 4215), would require PBMs to provide pharmacies with vital information on reimbursement for life-saving drugs and community pharmacy-provided services to Medicare Part D beneficiaries. The legislation would also help guarantee the utilization of appropriate pharmacy audit standards for PBMs contracting with the Medicare Part D program, helping infuse transparency and prevent the inappropriate denial of pharmacy reimbursement.
“Despite their claims to the contrary, PBMs drive up prescription drug costs through their opaque practices, restrict consumers’ choice of pharmacy, and use gimmicks to deny payments to pharmacies,” NACDS President & Chief Executive Officer Steven C. Anderson, IOM, CAE wrote in the letter. “Nothing is more important to chain pharmacy than the health and safety of their patients. We stand with you in your commitment to protecting the well-being of senior Americans.”
The legislation would also prohibit reduced pharmacy reimbursement stemming from clerical or recordkeeping errors, and ban extrapolation or other statistical tricks to unfairly calculate pharmacy recoupment and penalties.
“Your legislation will ensure that PBMs do not keep for themselves any payments recovered from their audits and that such payment recoveries are returned to the Prescription Drug Plan (PDP) sponsor,” Anderson stated. “Your legislation is an important step toward fully reining in the egregious practices of the PBMs.”
Last year, NACDS endorsed related bipartisan PBM transparency legislation, introduced by Representative McMorris Rodgers and U.S. Senator Mark Pryor (D-AR). That bill, the Pharmacy Competition and Consumer Choice Act (H.R. 1971 and S. 1058), includes provisions related to the frequency of updating maximum allowable cost (MAC) pricing, data usage, and the forced utilization of a PBM’s own mail order pharmacy, among other steps to prevent threats to pharmacy patient care.
Along with underscoring chain pharmacy’s support for the PBM transparency and standards bills, pharmacy advocates this week will urge lawmakers to oppose the anti-patient proposed merger of PBMs Express Scripts and Medco, whose union would likely only exacerbate the problems highlighted by the legislation. NACDS members and other pharmacy advocates will also promote the adoption of legislation to increase access to medication therapy management (MTM) services and ensure fair and adequate pharmacy reimbursement in federal healthcare programs.