NCPA to HHS: Ensure patients' access to pharmacies, enforce transparency rules for PBMs

ALEXANDRIA, Va. The lobby for the country’s independent pharmacies is urging the Department of Health and Human Services to ensure patients’ access to community pharmacies and enforce transparency rules for pharmacy benefit managers.

The National Community Pharmacists Association said Monday that it had asked HHS to adopt minimum pharmacy access standards in healthcare insurance exchanges. The NCPA also argued against tiered co-payments that favor one pharmacy provider, such as mail order, over others, and argued in favor of allowing any pharmacy willing to accept the terms of the pharmacy contract to participate.

The healthcare-reform law requires PBMs operating in the health-insurance exchanges to confidentially report such information as the percentage of all prescriptions provided through retail pharmacies compared with mail order, and the generic dispensing and substitution rates of each; the aggregate amount and types of rebates, discounts and price concessions that the PBM negotiates on behalf of the plan and the aggregate amount passed on to the plan sponsor; and the average aggregate difference between the amount the plan pays the PBM and the amount the PBM pays the retail and mail-order pharmacy.

“Access to this critical information will enable the [HHS secretary] and the health plans to better evaluate and, in turn, negotiate contracts for prescription drug benefit administration in order to contain costs and maximize consumer protections,” the NCPA said in its comments to HHS. “To date, there has been no clear direction as to where these new federal PBM discloser requirements should be included.”

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