Industry divided over proposed PBM restrictions
WASHINGTON —A bill introduced in the U.S. House of Representatives last month aims to increase requirements for pharmacy benefit managers and has angered PBMs while drawing praise from independent pharmacies.
H.R. 5234, the PBM Audit Reform and Transparency Act of 2010, introduced by Democratic Rep. Anthony Weiner of New York, would forbid PBMs that own pharmacies, or vice versa, from requiring patients to use their pharmacies or providing them with incentives to use them. It also would require them to give pharmacies a 15-day prior notice of audits, offer a written appeals process and limit audit periods to one year, and restrict their ability to share utilization and claims data. In addition, it would place new restrictions on their ability to share utilization and claims data, such as requiring them to notify health plans and insurers of their intent to share the data and disclose the name of the organization with which data are being shared, as well as allowing individual beneficiaries to opt out.
Independent pharmacy lobbying group the National Community Pharmacists Association heralded the bill. “This legislation would begin to rein in many of the dubious and opaque PBM practices that pad their burgeoning profits at the expense of patients, plan sponsors and local pharmacists,” NCPA president and Arlington, Texas, pharmacy owner Joseph Harmison said. “If this bill is enacted, PBMs would find it much harder to pad profits through hidden costs, to steer patients away from their pharmacy of choice and toward PBM mail-order pharmacies, and to punitively audit pharmacies. Ultimately, this proposal is about fixing the complex, broken system that PBMs have put in place to make billions of dollars while leaving patients and health-plan sponsors paying the bill and scratching their heads.”
The NCPA has shown little affection for PBMs, saying they have transformed “from simple claim processors to mammoth drug middlemen” that operate without transparency or regulation and whose profits have increased several times over the past decade as a result, in part by collecting rebates from drug manufacturers in exchange for favoring certain drugs over others.
Not surprisingly, the Pharmaceutical Care Management Association, the country’s largest lobbying group for PBMs, attacked the bill and the NCPA’s role in it, albeit without referring to the NCPA by name. “Unfortunately, the independent drug store lobby continues to push an agenda that increases prescription drug costs for consumers and payers and limits efforts to root out fraud, waste and abuse,” a statement released by the organization read. “Given the increased focus on controlling healthcare costs, we can’t afford to let anyone, including the independent pharmacy lobby, thwart congressional efforts to fight pharmacy fraud.”
The PCMA said PBMs provided such services as incentives for the use of generic drugs, electronic prescribing and mail-order pharmacies that improved safety, savings and access for payers and patients, and said that use of PBM services in Medicare Part D reduced the program’s expenditures by 43%. “Since the key to access is affordability, payers and policy-makers alike should explore broader use of PBMs’ cost-savings tools and reject approaches that make prescription drugs more expensive,” the PCMA’s statement read. According to a letter the group sent to Department of Health and Human Services secretary Kathleen Sebelius and Sen. Charles Grassley, R-Iowa, the bill would mandate that PBMs contract with pharmacies currently banned from participating in federal programs, oppose the Office of the Inspector General’s ability to prosecute pharmacists charged with a felony, require a lengthy waiting period to remove a pharmacy from a network despite “irrefutable” evidence of fraud and exempt independents from routine accreditation requirements to sell durable medical equipment.
Pennsylvania boosts pharmacists’ role; NACDS hails bid for collaboration
ALEXANDRIA, Va. In a gesture hailed by retail pharmacy advocates, the Keystone State is moving to expand the role its pharmacists play in improving patient health and outcomes.
The move comes with enactment of a Pennsylvania law, H.B. 1041, which will open new opportunities for collaborative medication therapy management between physicians and pharmacists on behalf of patients in a community pharmacy setting. Previously, such team approaches were permitted only in such institutional settings as hospitals and nursing homes in the state.
The National Association of Chain Drug Stores had high praise for the new law, calling it an “important victory,” and citing the efforts made by the Pennsylvania Association of Chain Drug Stores and the Pennsylvania Pharmacists Association toward its passage. “With the enactment of this legislation, Pennsylvania has said ‘yes’ to improving the health and lives of patients, and to reducing overall healthcare costs,” said NACDS president and CEO Steve Anderson. “This new law recognizes the expertise of pharmacists, the accessibility of community pharmacy and the ability of pharmacists to help patients properly manage their health conditions for the well-being of patients and for the good of society.”
Pennsylvania is the 33rd state to allow collaborative drug therapy management in the community setting, according to NACDS research. “Nine states allow it in institutional settings only, and eight do not allow it at all,” noted the group Friday.
Taro receives FDA approval for Kytril generic
HAWTHORNE, N.Y. Taro Pharmaceutical Industries has received approval from the Food and Drug Administration to market its generic version of a drug used to prevent nausea and vomiting in patients on chemotherapy, the Israeli generic drug maker said Friday.
The FDA approved Taro’s granisetron hydrochloride tablets in the 1-mg strength. The tablets are a generic version of Roche’s Kytril tablets.
Granisetron tablets had sales of around $15 million in 2009, according to unnamed industry sources cited by Taro.