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ALEXANDRIA, Va. — A report by the Department of Health and Human Services' Office of Inspector General found that beneficiary premiums in the Medicare Part D prescription drug program are higher than than they should be, due to overpayments to plan sponsors, including pharmacy benefit managers.
In response to this, the National Community Pharmacists Association's EVP and CEO, Kathleen Jaeger, underscored the need for greater PBM transparency to assure patient access to their pharmacies of choice and healthcare services are preserved, calling the report a "wake-up call to Congress."
“When tolerated in Medicare or other health plans, overpayments to PBMs needlessly drive up healthcare costs," Jaeger said. "They also create artificial, inflated pressure that can lead employers and other plan sponsors to consider restricting patient access to their community pharmacist or even requiring the use of mail order when other cost-saving methods are available, such as increasing appropriate use of generic medicines. Community pharmacists lower costs for patients and health plans by consistently dispensing generic drugs more frequently than PBM-owned, mail-order pharmacies."