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Community Pharmacists Endorse Bipartisan Pharmacy Competition and Consumer Choice Act
Date:5/24/2011

ttp://www.ncpanet.org/pdf/leg/pbmtranspappendixa.pdf">$370 million in recent years to settle claims of deceptive conduct and fraud, while their profits increased 400 percent. Recognizing this, Congress enacted bipartisan PBM disclosure legislation in 2010 that applies to Medicare Part D and the state health exchanges that are expected to launch in 2014. The McMorris Rodgers-Weiner proposal would extend these protections to private insurance plans and patients. Plan sponsors would be better able to drive a better bargain and reduce costs by identifying costly profit-padding practices, such as switching patients to costlier drugs, hoarding manufacturer rebates and billing plans inflated amounts for prescription claims.
  • Level the playing field among pharmacies. "Restricted network" plans limit patients to a specified list of pharmacies, usually without independent community pharmacies ever having an opportunity to compete for the business. The legislation would allow "any willing provider" that agrees to accept a health plan's terms and reimbursement rates to participate in that plan, so long as the pharmacy is licensed in that particular state and eligible to participate in federal and state health plans (which remove any providers that commit fraud). The bill would also ensure that private plans provide pharmacies with timely reimbursement, as required under Medicare Part D, rather than delaying the payments to generate interest from those funds. In addition, the bill would give pharmacies basic information about how the PBM determines reimbursement rates (e.g., Maximum Allowable Costs, or MACs) and requires those rates to be updated frequently to reflect
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  • SOURCE National Community Pharmacists Association
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