NCPA backs federal employee benefits bill, makes recommendations

ALEXANDRIA, Va. In a letter to Rep. Stephen Lynch, D-Mass., the National Community Pharmacists Association’s chief executive and EVP offered support and recommendations for improving a recently introduced bill designed to improve federal employees' drug benefits.

NCPA's Bruce Roberts said Friday he commended Lynch for including provisions designed to create greater transparency that could lead to savings in the Federal Employees Health Benefits program, which includes prescription drug services. H.R. 4489, better known as the FEHBP Prescription Drug Integrity, Transparency and Cost Savings Act, would expand the Office of Personnel Management’s oversight capabilities for the program.

NCPA's EVP and CEO agreed with the following provisions:

  • Giving OPM access to data from drug manufacturers and pharmacy benefit managers (PBMs) on deals to promote the usage of certain drugs over others, and forcing the PBMs to “pass through 99% of rebates earned on behalf of plan sponsors” as opposed to keeping those resources to themselves.
  • Exposing mechanisms that reveal PBMs’ manipulation of the pricing structure “by using different reimbursement bases for prescriptions dispensed by mail order pharmacies compared to retail pharmacies,” which benefits PBMs since they own mail order pharmacies.
  • Assuring that patients “receive the prescription drug actually prescribed by their physician,” which would end the PBM drug switching unless “approved by the provider and results in actual savings to the plan”.
  • Prohibiting PBM ownership of retail pharmacies to “eliminate the conflicts of interest that are inherent when a manufacturer exerts a controlling interest in a PBM or when a retail pharmacy owns a controlling interest in a PBM.”

Roberts said, however, that some parts of the bill should be modified, stating that "other provisions that should be amended to prevent unintended, but possibly deleterious, consequences to pharmacies and their patients." One point: to redefine the idea of using the average manufacturer price for drugs as a pricing benchmark for carrier plans.

"The current language establishes that the amount that the carrier plan may pay a PBM for a prescription drug may not exceed the drug’s average manufacturer price," Roberts said. "The use of AMP as a pricing benchmark for the carrier, and in turn the pharmacy provider, is problematic unless AMP were to be significantly redefined or increased in such a way that truly reflects the retail pharmacy acquisition cost of a prescription drug, which is higher than a drug’s current AMP. Moreover, use of AMP would be inappropriate to pay for generic drugs because of the need for reimbursement policies to encourage the use of generics.

“In addition, the definition of AMP in the legislation is not appropriate because it includes mail order sales. It should only reflect sales to retail pharmacies. Without modification of these provisions, community pharmacy participation in the program would be threatened, reducing patients’ access to prescription medications,” Roberts added.

A complete copy of the letter can be found here.

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