PCMA Responds to Report from the Majority Staff of the House Committee on Oversight and Government Reform

October 15, 2007

(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) released the following statement in response to a new report on Medicare Part D from the Majority Staff of the House Committee on Oversight and Government Reform:.

“The Medicare Modernization Act of 2003 (MMA) was created to provide seniors and the disabled with safe, affordable drug benefit options. Since traditional fee-for-service Medicare had no prior experience in this field, the government looked to pharmacy benefit managers (PBMs) because of their proven track record of expanding access to prescription drugs and lowering costs for more than 210 million Americans covered by employer, union and government plans.

“Thousands of payers—including the Federal Employees Health Benefits Program (FEHBP) used by Member of Congress—rely upon proven PBM tools to manage prescription drug costs. These tools, which include rebates, generic drug utilization, and the mail-service pharmacy option, have reduced the rate of growth in prescription drug spending to its lowest level in over a decade, according to data released earlier this year from researchers at the Centers for Medicare & Medicaid Services (CMS).

“In Part D, PBMs have worked hard to meet the justifiably high expectations of seniors and policymakers alike. While there is always room for improvement, PBMs are proud of their performance to date. PBMs and Part D sponsors have lowered costs 30 percent beneath government projections, offered lower premiums than expected, generated more generic utilization than Medicaid and provided more choice of drugs and pharmacies than the Veterans’ Administration program. Most importantly, America’s seniors are pleased with Part D’s performance.

“For the first time in Medicare, PBMs have introduced important new advances to improve safety, choice, and affordability in Part D. Specifically, Part D plans:

  • Use sophisticated Drug Utilization Review (DUR) programs to help improve drug safety and prevent fraud;
  • Implement cutting-edge strategies to increase generic utilization;
  • Negotiate competitive discounts among networks of over 55,000 retail and mail service pharmacies across America;
  • Negotiate with Pharmacy Service Administrative Organizations (PSAOs), which collectively bargain and process payments on behalf of independent pharmacies;
  • Offer real-time Medication Therapy Management (MTM) programs to improve safety for seniors who take multiple prescriptions for chronic conditions;
  • Offer an array of benefit designs for beneficiaries to choose from according to their medical and economic needs;
  • Provide broad access to thousands of prescription drugs
  • Aggressively negotiate discounts with brand manufacturers; and
  • Pass on savings in the form of lower negotiated drug prices (including in the ‘donut hole’), premiums, co-pays, and deductibles.
  • “Generating more generic utilization than Medicaid and more drug and pharmacy options than the VA, PBMs have helped bring to Medicare what millions of seniors previously enjoyed in private retirement programs: affordable, flexible and safe drug benefits.”

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    PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

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