The Pharmaceutical Care Management Association (PCMA) is the national association representing America’s pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, managed Medicaid plans, and others.

PCMA continues to lead the effort in promoting PBMs and the proven tools they utilize, which are recognized by consumers, employers, policymakers, and others as key drivers in lowering prescription drug costs and increasing access.

PBMs are projected to save employers, unions, government programs, and consumers $654 billion – up to 30 percent – on drug benefit costs over the next decade, according to research from Visante.

PBMs reduce drug costs by:

  • Offering Amazon-style home delivery of medications and creating select networks of more affordable pharmacies;
  • Encouraging the use of generics and more affordable brand medications;
  • Negotiating rebates from drug manufacturers and discounts from drugstores;
  • Managing high-cost specialty medications;
  • Reducing waste and improving adherence.

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PBMs: Committed to Helping Patients

The Critical Path Forward: Rx
Policies to Reduce Patient Costs,
Improve Access

For America’s pharmacy benefit managers, PBMs, our core mission is to increase access to affordable prescription drugs for all Americans.

But more can be done and we stand ready to be part of the solution.

PCMA’s Policy Platform, outlined below, presents straightforward solutions that, taken together, would lower prescription drug costs and make pharmaceutical care even more accessible for all Americans.

This policy platform would result in total Federal Savings of $257.5 billion to $398.7 billion over ten years.

This policy platform would result in total Federal Savings of $257.5 billion to $398.7 billion over ten years.

PART ONE

Modernize Medicare Part D

In its first 15 years, Medicare Part D has significantly improved the affordability of prescription drugs for people with Medicare.

PBMs support a set of proposals, which, taken together, would modernize Part D and better align the incentives of all stakeholders to control drug costs and improve quality and outcomes for beneficiaries. These include policies to:

A) Improve Affordability
B) End Misaligned Incentives
C) Increase Choice and Competition
D) Keep Premiums Affordable
E) Achieve The Triple Aim

Modernize Medicare Part D

Total Federal Savings:

$196.3 billion to
$280.3 billion over
ten years.

A) Improve Affordability

Unlike most patients with commercial drug coverage, Part D beneficiaries can face unexpected, high costs because
the Part D drug benefit does not have an annual limit on out-of-pocket spending.

We should cap annual out-of-pocket costs to provide better financial protection for beneficiaries with high drug costs
and make cost-sharing more affordable and manageable.

B) End Misaligned Incentives

Rather than lowering the increasingly high prices they set for their drugs, manufacturers want to shrink the discounts they owe Part D beneficiaries and taxpayers.

Instead, to lower drug prices and reduce costs, we should end misaligned incentives and hold manufacturers accountable for their high prices and require manufacturer contributions throughout the Part D benefit phase—from Initial Coverage to Catastrophic.*

*We believe that manufacturer responsibility should be higher in the Catastrophic Coverage phase and particularly for protected-class drugs and novel drugs without therapeutic competition and very high costs.

C) Increase Choice and Competition

The most important barrier to bringing costs down is the lack of competition and rules that stymie beneficiary choice and competition. By increasing competition, we can lower costs, increase access, and drive continued innovation in Part D.

We should build on Part D’s record of success by eliminating the two drugs per-class requirement; allowing select exclusions of the protected classes; encouraging beneficiaries to use lower cost drugs, such as generics and biosimilars; and promoting greater plan choices for beneficiaries.

D) Keep Premiums Affordable

The rebate rule, which limits plans and PBMs from negotiating lower drug costs on behalf of Part D beneficiaries, would increase premiums 25% and cost taxpayers $170 billion.

A 2019 Government Accountability Office report found that PBMs passed 99.6% of all rebates on to plan sponsors, helping keep premiums and costs low. We should repeal the “rebate rule” and advance real solutions to bring down drug costs.