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New Study: H.R. 4577 to Cost $21 Billion over 10 Years
Date:7/22/2014

Health Resources & Services Administration (HRSA) indicates that 94.77% of all Medicare Part D enrollees reside in counties meeting at least one of the "underserved area" criteria established in this legislation.
  • After offsets, we estimate that enactment of this legislation would increase Federal mandatory spending by $21.32 billion over the 2015-2024 scoring window.
  • "This is a backdoor attempt to ban the popular, low premium plans that encourage shopping at more affordable pharmacies," said PCMA President and CEO Mark Merritt. "How can plans reduce premiums if their 'discount networks' have to include each community's highest-priced drugstore?"

    The Federal Trade Commission (FTC) recently wrote a letter to the Centers for Medicare and Medicare Services (CMS) on any willing pharmacy provisions included in the agency's Medicare Part D rule.  The FTC warned that:

    "The proposed any willing pharmacy provisions threaten the effectiveness of selective contracting with pharmacies as a tool for lowering costs. Requiring prescription drug plans to contract with any willing pharmacy would reduce the ability of plans to obtain price discounts based on the prospect of increased patient volume and thus impair the ability of prescription drug plans to negotiate the best prices with pharmacies.

    "Evidence suggests that prescription drug prices are likely to rise if Prescription Drug Plans ("PDPs") are less able to assemble selective pharmacy networks. The proposed provisions may also hinder the ability of plans to steer beneficiaries to lower-cost, preferred pharmacies and preferred mail order."

    PCMA represents the nation's pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 216 million Americans.


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    SOURCE Pharmaceutical Care Management Association
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