Navigation Links
NCPA Applauds Rep. Weiner for Introducing Bill to Rein in Pharmacy Benefit Manager Practices That Hurt Patients, Plan Sponsors and Community Pharmacies
Date:5/6/2010

ALEXANDRIA, Va., May 6 /PRNewswire-USNewswire/ --The National Community Pharmacists Association today endorsed H.R. 5234, the PBM Audit Reform and Transparency Act of 2010, which would aim to reduce health care costs by requiring greater transparency of pharmacy benefit managers (PBM) -- the largely unaccountable giant prescription drug plan administrators, such as CVS Caremark, Express Scripts, Inc. and Medco Health Solutions, Inc.

(Logo:  http://www.newscom.com/cgi-bin/prnh/20100106/DC33253LOGO )

Introduced by U.S. Representative Anthony Weiner (D-N.Y.), H.R. 5234 would limit ownership conflicts of interest, discourage abusive pharmacy auditing practices, and require greater PBM disclosure with patients and plan sponsors.

"This legislation would begin to rein in many of the dubious and opaque PBM practices that pad their burgeoning profits at the expense of patients, plan sponsors and local pharmacists," said Joseph H. Harmison, PD, NCPA president and pharmacy owner in Arlington, TX. "If this bill is enacted, PBMs would find it much harder to pad profits through hidden costs, to steer patients away from their pharmacy of choice and towards PBM mail order pharmacies and to punitively audit pharmacies. Ultimately, this proposal's about fixing the complex, broken system that PBMs have put in place to make billions of dollars while leaving patients and health plan sponsors paying the bill and scratching their heads."

Harmison added, "NCPA wants to personally thank Representative Weiner for his strong leadership on this issue. We hope the House takes up this important bill this year, and that their Senate counterparts act with a similar sense of urgency."

PBMs have transformed themselves from simple claim processors to mammoth drug middlemen who operate with virtual impunity due to a lack of both transparency and regulation. Some of the largest PBMs enjoyed a fivefold increase in profits over the past decade. To fuel record profits, PBMs collect rebates from drug manufacturers for favoring certain drugs over others, but do not share them equitably with patients or plan sponsors. PBMs also require or strongly encourage patients to leave their community pharmacy for PBM-owned mail order pharmacies, even in cases when the resulting cost is higher to the health plan.

Recently, states have begun to more closely regulate PBMs and have secured more than $300 million in compensation to settle lawsuits filed by state attorneys general. H.R. 5234 offers a regulatory framework at the federal level with provisions requiring PBMs to:

  • Disclose to plan sponsors in an annual report the number/total cost of prescriptions under the contract filled at mail and retail; aggregate average payments under the contract per prescription made to mail and retail and average amount per prescription the PBM received; overall percentage of generics dispensed at mail and retail; and percentage and number of cases patients where switched to a more costly drug.
  • Identify sources for maximum allowable cost (MAC) pricing and reimbursement benchmarks and update weekly; follow prompt pay provisions (consistent with the Medicare Part D prescription benefit); and be non-discriminatory regarding pharmacy network participation.
  • Cease ownership conflicts of interest by preventing PBMs from mandating that patients use a specific pharmacy (retail, mail, specialty) if the PBM has an ownership interest in that pharmacy (or vice versa); and prohibit the offering of incentives to encourage patients to use only the PBM-owned pharmacy.
  • Give pharmacies a 15-day prior notice of audits; offer a written appeals process; limit the audit period to one year; and disclose audit recoupment to the plan sponsor.
  • Protect patients by placing restrictions on the sale/utilization of claims data and other patient information.

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com.  


'/>"/>
SOURCE National Community Pharmacists Association
Copyright©2010 PR Newswire.
All rights reserved

Related medicine technology :

1. Wireless-Life Sciences Alliance (WLSA) Applauds Partner Organizations for Supporting Goal of Improving Healthcare Via Wireless Technologies
2. MedSolutions Applauds Renewed Focus on the Dangers of Radiation Exposure
3. American Association for Homecare Proposes Strong Anti-Fraud Measures in Medicare, Applauds HHS Testimony Today That Pledges to "Stop Fraud Before it Starts"
4. Narconon of Georgia Applauds Efforts of Prescription Buy-Back Programs
5. ARUP Laboratories Applauds FDAs Decision on the Value of KRAS-Mutation Testing in Colorectal Cancer
6. Society of Interventional Radiology Applauds Reports Uterine Fibroid Embolization Recommendations
7. Wyeth Applauds Six Countries Across Europe, and the Middle East, That Recently Announced the Inclusion of the 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in Their Immunization Schedules
8. Epeius Biotechnologies Applauds the Belated Scholarship of Their Academic Contemporaries in 2007, As Targeted Gene Therapy Comes of Age in Clinical Medicine
9. Filtrona Porous Technologies Realizes Innovative New Product Development Through Foam-Fiber Technology Synergy : Introducing MediSponge(R) RBR Wound Care Dressings
10. Pharmacyclics to Present at Bank of America Merrill Lynch Healthcare Conference and MDB Bright Lights Conference
11. Fake Pharmacy Licenses, No-Prescription Meds OK with Internet Companies, LegitScript Reports
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/23/2016)... Roche (SIX: RO, ROG; OTCQX: RHHBY) announced ... BRAHMS PCT (procalcitonin) assay as a dedicated testing solution ... this clearance, Roche is the first IVD company in ... sepsis risk assessment and management. PCT is ... levels in blood can aid clinicians in assessing the ...
(Date:6/23/2016)... 23, 2016 Bracket , a leading clinical ... generation clinical outcomes platform, Bracket eCOA (SM) 6.0, at ... 26 – 30, 2016 in Philadelphia , ... Outcome Assessment product of its kind to fully integrate with ... Bracket eCOA 6.0 is a flexible platform for electronic clinical ...
(Date:6/23/2016)... Revolutionary technology includes multi-speaker listening ... industry leaders in advanced audiology and hearing aid technology, ... ™, the world,s first internet connected hearing aid that ...      (Photo: http://photos.prnewswire.com/prnh/20160622/382240 ) , ... ,world firsts,: , TwinLink™ - the first ...
Breaking Medicine Technology:
(Date:6/25/2016)... , ... June 25, 2016 , ... Conventional wisdom preaches ... success. In terms of the latter, setting the bar too high can result in ... than just slow progress toward their goal. , Research from PsychTests.com ...
(Date:6/24/2016)... ... 2016 , ... Marcy was in a crisis. Her son James, eight, was out of control. ... and physically. , “When something upset him, he couldn’t control his emotions,” remembers Marcy. ... rocks at my other children and say he was going to kill them. If ...
(Date:6/24/2016)... ... 24, 2016 , ... Comfort Keepers® of San Diego, CA is excited to ... Recovery® program to drive cancer patients to and from their cancer treatments. Comfort ... quality of life and ongoing independence. Getting to and from medical treatments is ...
(Date:6/24/2016)... ... June 24, 2016 , ... The ... recognize Dr. Barry M. Weintraub as a prominent plastic surgeon and the network’s ... the world, and the most handsome men, look naturally attractive. Plastic surgery should ...
(Date:6/24/2016)... ... June 24, 2016 , ... Venture Construction Group (VCG) ... held on June 20th at the Woodmont Country Club at 1201 Rockville Pike, Rockville, ... dedicated to helping service members that have been wounded in battle and their families. ...
Breaking Medicine News(10 mins):