National LTC Pharmacy Group Praises Proposed CMS Rule for Recognizing PBM Abuses, Proposing Ways to Stop Them

DATE: November 28, 2017

SCPC Also Lauds Implementation of 2016 CARA Bill Recognizing Essential Difference Between LTC and Retail Pharmacies

Washington, DC — The Senior Care Pharmacy Coalition (SCPC) today praised the newly proposed CMS rule (Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program) for recognizing extensive abuses perpetrated by the pharmacy benefit manager (PBM) industry on a wide range of stakeholders, and proposing methods to address them.

Alan G. Rosenbloom, President and CEO of SCPC, also noted the proposed rule implements the Comprehensive Addiction and Recovery Act (CARA), which includes the Part D lock-in provision and SCPC’s hard-fought exemption language for Part D beneficiaries in LTC facilities.

“We commend CMS for recognizing that PBMs have a deleterious, abusive impact on a wide swath of the nation’s prescription drug pricing chain, and for proposing the means by which to address them,” stated Rosenbloom. “It is significant that CMS expressly states PBMs are earning Direct and Indirect Remuneration (DIR) fees that are not passed on to beneficiaries or the Medicare program, which flatly contradicts PBMs’ disingenuous propaganda on this important policy matter.”

Rosenbloom also said, “SCPC is gratified and proud to see our 2016 legislative effort surrounding the CARA come to fruition in the proposed rule.”

The SCPC leader reiterated SCPC’s thanks to Senators Pat Toomey (R-PA), Rob Portman (R-OH), Tim Kaine (D-VA) and Sherrod Brown (D-OH), and U.S. Reps. Fred Upton (R-MI), Frank Pallone (D-NJ), Gus Bilirakis (R-FL) and Ben Ray Lujan (D-NM) for their leadership and foresight in recognizing LTC pharmacies as a unique sector within the broader pharmacy space. “CARA strikes the right balance between protecting our citizens and communities on the one hand, and protecting the ability of LTC pharmacies to meet and manage the medication needs of LTC residents on the other,” Rosenbloom continued.

Specifically, CARA exempts Medicare Part D beneficiaries in skilled nursing facilities (SNFs) and other settings from a previously proposed medication management “lock-in” provision under Medicare Part D. As legislative language advanced through both chambers, SCPC consistently made the case that beneficiaries in SNFs and other long-term care settings already have sufficient protections from drug abuse and diversion, and should be exempted.

Said Rosenbloom: “The exemption is a vital provision that specifically recognizes the unique characteristics of the long-term care patient population and the distinctions between specialized long-term care pharmacies and more well-known retail pharmacies — particularly the additional requirements already imposed on LTC pharmacies under Medicare and Medicaid Requirements of Participation and Medicare Part D rules.”

Rosenbloom said SCPC — the only federal advocacy organization devoted exclusively to the interests of the nation’s LTC pharmacies and the patients they serve — will continue to analyze the 700-page proposed rule and comment further as warranted.

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The SCPC is the national association for independent LTC pharmacies. Our member pharmacies provide care and services to patients in LTC facilities across the country occupying approximately 675,000 beds. Visit us at www.seniorcarepharmacies.org to learn more.