NCPA and three Oregon legislators push for greater oversight, transparency of PBMs

ALEXANDRIA, Va. — The National Community Pharmacists Association on Wednesday urged Oregon state lawmakers to pass a series of bills that would "collectively reduce red tape for pharmacists caring for patients, give consumers greater pharmacy choice at no extra cost, and keep more revenue within the state."

NCPA has identified four issues of import:

  • The first is setting reasonable standards for pharmacy audits to protect against fraud without abusing the system. According to NCPA, audits claim thousands of dollars from Oregon pharmacists and small business owners even when the correct medication is dispensed to the correct customer for the correct price. Recently, 22 different states have passed audit reform legislation, the association noted;
  • Second, legislation that would focus on freeing patients from requirements that use out-of-state mail order pharmacies by allowing them to transfer their prescription to a local pharmacy that agrees to accept the same terms and conditions, including reimbursement rates. This legislation is similar to that adopted in the last legislative sessions in both New York and Pennsylvania. National consumer surveys conducted by J.D. Power and Associates, Consumer Reports and others have documented patients’ preference and higher satisfaction rates with local pharmacies, NCPA noted;
  • Third, maximum allowable costs are the system PBMs use to determine how much they will reimburse pharmacies, mostly for generic prescription drugs that comprise 80% of what is dispensed to patients. Unfortunately, pharmacies are kept in the dark about the pricing changes for these products, NCPA stated. "Thus, these small business providers are 'flying blind' in terms of taking into account the operating costs of their prescription drug inventory. The legislative remedy would allow pharmacists simply to know how the MACs are determined and make sure that timely updates are made to reflect market prices."; and
  • Fourth, NCPA is addressing the lack of transparency in PBM contracting practices. "Health plan sponsors and patients are left in the dark about the validity and soundness of how their prescription drug benefits are being administered. Greater transparency into this often secretive and byzantine sector can facilitate better evaluation of PBM performance."

Spear-heading the effort is State Rep. Jules Bailey, D-Portland, who has organized a bipartisan working group with State Reps. Jim Thompson, R-Dallas, and Margaret Doherty, D-Tigard, to generate consensus solutions. 

“My interests in this legislation come from listening to my constituents,” Bailey stated. “Patients tell me about their maddening experiences navigating the PBM bureaucracy to get vital prescription drugs at a reasonable price and in a timely fashion. Pharmacists tell me about how PBMs squeeze them to the breaking point as a result of the onerous, take-it-or-leave-it contracts they must sign to have access to patients and about abusive PBM audit practices. The universal complaint is that the current system is broken," he said. "When people learn about all the questionable business tactics PBMs are allowed to employ on a daily basis without any accountability they are amazed. … While regulation for regulation’s sake is not a panacea, the utter lack of regulation when it comes to the PBM industry must end. I hope my fellow legislators, the governor and people of Oregon will join us in demanding reform. Without these proactive steps patients, health plan sponsors and pharmacies will continue to get the short end of the stick.”

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