(Washington, DC)— The Pharmaceutical Care Management Association (PCMA) issued the following statement today in response to the National Community Pharmacists Association’s (NCPA) recent use of an unrelated AARP report on drug manufacturer prices as an excuse to attack America’s pharmacy benefit managers (PBMs):

“Despite recent press revelations of its ‘top secret’ lobbying campaign to maintain the confidentiality of its own Medicaid pricing information, the independent drugstore lobby continues to demand more ‘transparency’ for others in the pharmacy supply chain, most notably PBMs.

“Unlike independent drugstores, PBMs are hired by payers to drive down prescription costs, not maximize reimbursements.  Proven PBM tools — including incentivizing the use of generic medications — have helped result in the Medicare Part D program costing $373 billion, a 41 percent drop from the initial cost estimate of $634 billion for 2004-2013.

“By demanding more transparency for others and less for themselves, NCPA’s ‘disclosure double standard’ campaign puts its Congressional and retail pharmacy allies in the embarrassing role of attacking and defending the same policy, depending on whether it applies to themselves or other members of the pharmacy supply chain.

“Though NCPA sidesteps the fact that the federal ‘transparency’ law already applies to PBMs — but not independent retailers — an interesting irony remains: independent drugstores are themselves the least ‘transparent’ part of today’s pharmacy supply chain. Their unwise, high-profile ‘disclosure double standard’ strategy is largely responsible for Washington’s growing interest in more retail transparency in Medicaid and other programs.”

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“Pharmacy benefit managers (PBMs) have pioneered tools – including incentivizing the use of generic medications, e-prescribing, and mail-service pharmacies – that improve savings, access, and safety for consumers and payers.  Since the key to access is affordability, payers and policymakers alike should explore broader use of PBMs’ cost-saving tools in order to combat the consistent increases in drug prices by drugmakers. Options to increase competition and reduce costs include:

• Stop Giving ‘Me-Too’ Drugs a Free Ride in Medicare.  Regrettably, Medicare Part D insulates drugmakers from competition by requiring drug plans to cover ‘all or substantially all’ drugs in at least six different drug classes, despite no evidence that patients had difficulty accessing these drugs. In doing so, this provision merely allows brand-name drugmakers to charge more because they know plans are required to include their drugs on formularies, whether they offer discounts or not.
• Expanding mail-service pharmacy options. While numerous independent studies have documented that mail-service pharmacies reduce drug costs and provide greater safety and convenience, Medicare beneficiaries are not given the same incentives to use this proven delivery system as the under-65 population. This is costly and unfortunate since home delivery reduces costs and increases convenience for seniors and the disabled.”

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(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) issued the following statement on research cited by the Centers for Medicare & Medicaid Services (CMS) that found the most recent 10-year cost estimate for Medicare Part D came in at $373 billion, a 41 percent drop from the initial cost estimate of $634 billion for 2004-2013:

“The latest reduced CMS Part D cost estimate highlights that proven pharmacy benefit management tools utilized by Part D plans are saving money without sacrificing beneficiaries’ prescription drug choices.   In its analysis, CMS noted that ‘plans are negotiating better pricing than anticipated’ resulting in the benefit now costing $373 billion, a 41 percent drop from the initial cost estimate of $634 billion for 2004-2013.   Additional savings would result from the greater use of mail-service pharmacies and more flexible formularies.

“As Medicaid expands under PPACA, policymakers should explore the Part D model for consumer-friendly ways to reduce wasteful spending in Medicaid pharmacy.”

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(Washington, DC)— A recent Centers for Medicare & Medicaid Services (CMS) Request for Proposal (RFP) requiring a “nationwide survey of consumer purchase prices” for drugs at retail pharmacies in Medicaid is consistent with the demands which the independent pharmacy lobby has made of others in the pharmacy supply chain for the past decade.  Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt released the following statement today regarding a new blog post in Drug Channels.net detailing a “top secret” letter the independent drugstore lobby sent to CMS opposing a new pharmacy transparency initiative:

“We can’t have a double standard in which drugstores are shielded from the same type of transparency they routinely demand of PBMs.  This is especially true of the independent drugstore lobby, which has for years demanded more ‘transparency’ of others in the pharmacy supply chain.  Now, they have an opportunity to provide more of it themselves.  A good place to start would be to release the ‘top secret’ letter opposing pharmacy transparency that they sent to CMS.

“Regardless of the substance of CMS’ request, independent drugstores have only themselves to thank for bringing this upon the retail pharmacy community.  Since independent drugstores are now the least transparent part of the pharmacy supply chain, it should be no surprise that their own decade-long campaign for ‘transparency’ has finally come full circle.”

The RFP states the survey: “will afford State Medicaid agencies a valid array of covered outpatient drug prices from ingredient costs paid by retail community pharmacies to those prices available to the consumer.  Additionally, on an annual basis the contractor will obtain from the State Medicaid Agencies information on their prescription drug payment and utilization rates and prepare a comparative report ranking the performance of the States’ reimbursement prices to the retail prices collected in the survey.”

“Following the passage of health reform, an increased emphasis on overall program integrity and safeguarding taxpayer money is more important than ever.  Focusing on preventing fraud, waste, and abuse is integral to these efforts.

“Along with these initiatives, policymakers must reject policies that inadvertently weaken the ability of public and private payers to detect and prevent fraud, waste, and abuse.  It’s far easier to prevent fraud than to engage in ‘pay and chase’ activities after the fact.”

(Washington, DC)—The American health care system saved more than $824 billion through the use of generic medicines over the last decade, according to a new study released by the Generic Pharmaceutical Association (GPhA).  The analysis conducted by IMS Health highlights the value of this important cost-saving tool utilized by pharmacy benefit managers (PBMs), the Pharmaceutical Care Management Association (PCMA) said today.

 “When supported by other PBM tools like e-prescribing and home delivery, generic drugs are key drivers in improving outcomes and lowering costs,” said PCMA President and CEO Mark Merritt. “By fully leveraging the generic opportunity, policymakers can increase access and savings for consumers and payers.”

Key findings from the IMS report include:

• In 2009 alone, the use of FDA-approved generics saved $139.6 billion—a 15% growth over the prior year’s savings—or about $382 million every day.
• Savings generated by new generics will continue to increase as $89 billion in branded drug sales will lose patent protection over the next five years.

(Washington, DC)— Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt issued the following statement today on the recent U.S. House Appropriations Labor, Health and Human Services, Education, and Related Agencies subcommittee vote to provide the Department of Health and Human Services (HHS) Inspector General, the Centers for Medicare and Medicaid Services (CMS), and the Justice Department with $561 million for programs designed to combat fraud, waste, and abuse:

“As coverage expands under the new health reform law, it’s more important than ever to enhance America’s overall program integrity capabilities.  The Administration has noted that these kinds of efforts can save almost $10 billion. 

“The other side of the anti-fraud coin is that policymakers must reject policies that inadvertently weaken the ability of public and private payers to detect and prevent waste, fraud, and abuse.  It’s far easier to prevent fraud than to engage in ‘pay and chase’ activities after the fact.”

(Washington, DC)— Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt issued the following statement on the release of today’s “meaningful use” final rules in the Health Information Technology for Economic and Clinical Health (HITECH) Act:

“While we applaud this important step forward and believe that HITECH will play a historic role in promoting HIT adoption, we hope that regulators will do more down the road to ensure that the full safety and savings benefits of e-prescribing are realized on behalf of America’s patients.

“We believe, for example, that providers who receive HITECH payments should perform ‘e-prescribing safety checks’ to prevent dangerous medication errors, and think that certified EHR products should support — and providers should use — all the safety and savings components of e-prescribing as defined in Medicare Part D.  Despite these concerns, however, we are pleased that more physicians continue to adopt e-prescribing every day and are certain that HITECH will accelerate that process tremendously.”

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Merritt: ‘A Major Victory for Consumers and Payers Who Want Lower Prescription Drug Costs’

(Washington, DC)— In a major victory for consumers and payers, the U.S. Court of Appeals for the District of Columbia today struck down a District law that would have designated pharmacy benefit managers (PBMs) as “fiduciaries.”  The Court found the key portions of the law, Title II of the DC AccessRx Act of 2004, unconstitutional.  A three-judge panel unanimously affirmed a 2009 District Court ruling, finding that, since PBMs engage in claims administration for their clients and are regulated exclusively by Federal ERISA law, states and municipalities cannot impose such requirements.

“This ruling from one of the most respected Federal Appeals Courts in the country allows PBMs to continue to work aggressively to reduce the costs and improve the quality of prescription drug benefits for the 200 million Americans they serve,” said Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt.   

The D.C. law never went into effect, as a result of an immediate injunction issued by a lower court and subsequent Court rulings. The Court specifically rejected a contrary holding  relating to a “nearly identical” Maine statute issued by another Appeals Court, stating that “in our view the uniform administrative scheme encouraged by ERISA includes plan administrative functions performed by a third party on behalf of an EBP [employee benefits plan].”

Dozens of states have rejected legislation imposing similar requirements on PBMs upon realizing that such proposals inadvertently raise, not reduce, prescription drug costs.

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Mail-Service Pharmacies Provide Increased Savings, Safety, and Adherence

(Washington, DC)— Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt issued the following statement on today’s House Subcommittee on Federal Workforce, Postal Service, and the District of Columbia and the Senate Subcommittee on Federal Management, Government Information, Federal Service, and International Security joint hearing on the postal service.  Among other items, the hearing will examine a proposal that would reduce delivery of mail to five days which could negatively impact the millions of Americans with chronic conditions who rely on the convenience and value provided by mail-service pharmacies:

“About 1-in-6 prescriptions that are home delivered arrive on Saturday.  Consumers count on getting their prescriptions at the right time and shouldn’t be made to wait two, or in the case of federal holidays that fall on a Monday, three days.

“Surveys show that recipients of prescription drugs by mail – a majority of which are delivered by the USPS – are highly satisfied with mail-service pharmacies, as they are convenient, safe, and save consumers money.  Peer-reviewed research has demonstrated that home delivery of prescription medications can increase adherence to drug regimens for the chronically ill, such as those with diabetes.  Additional research has also shown mail-service pharmacies dispense prescriptions with far greater accuracy and cost consumers less than ‘brick-and-mortar’ pharmacies.”

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