National LTC Pharmacy Leader: PBM Drug Pricing Middlemen Face Growing Barrage of Criticism from Widening Group of Bipartisan Lawmakers
Washington, DC — In praising U.S. Reps. Doug Collins (R-GA) and Dave Loebsack (D-IA) for introducing the Prescription Drug Price Transparency Act (H.R. 1316), Senior Care Pharmacy Coalition (SCPC) President and CEO Alan G. Rosenbloom observed that the nation’s drug pricing middlemen — Pharmacy Benefit Managers (PBMs) — are rightly facing a growing barrage of criticism from a widening group of bipartisan lawmakers demanding answers about rising prescription drug prices, and the practices driving increases.
“The nation’s long term care (LTC) pharmacies thank Congressmen Collins and Loebsack for their ongoing role as bipartisan national leaders in bringing more accountability and increased transparency to generic prescription drug pricing,” said Rosenbloom. “Secretive, opaque PBM pricing practices make it impossible for LTC pharmacies to predict how they will be reimbursed for the generic drugs they dispense under Medicare Part D — and passage of H.R. 1316 would be a strong first step towards more equitable, transparent reimbursement for LTC pharmacies dispensing generic drugs to seniors.”
The national LTC pharmacy leader also thanked H.R. 1316’s original sponsors, Reps. Buddy Carter (R-GA), Brian Babin (R-TX), Cathy McMorris Rodgers (R-WA), John Sarbanes (D-MD), Rod Blum (R-IA) and John Duncan (R-TN).
Under Medicare Part D, the largest payer for prescription medications in LTC facilities, the PBMs that administer Prescription Drug Plans (PDPs) — often owned by the PDPs or a shared parent company — use a Maximum Allowable Cost (MAC) pricing formula to establish reimbursement rates for a majority of generic drugs LTC pharmacies dispense to elderly Medicare beneficiaries.
Rosenbloom praised Collins and Loebsack for their sustained effort to spotlight how PBMs surreptitiously develop and alter their MAC pricing lists without disclosing how they determine which drugs to include on the lists, how those prices are established, or how frequently those prices are updated — rendering the process completely opaque.
LTC pharmacies serve a crucial clinical care role for a growing population of medically-compromised seniors in Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs) facing rehabilitation and/or extended custodial care. These Americans significantly benefit from the specialized services and medication management services only long term care (LTC) pharmacies, and the consulting pharmacists they employ, can provide.
“MAC pricing remains a serious challenge to LTC pharmacies’ ongoing ability to provide the extensive array of services LTC patients require, and which federal law mandates LTC pharmacies provide,” Rosenbloom continued.
Last week, S. 413 and H.R. 1038 were introduced respectively by Senators Shelley Moore Capito (R-WV) and Jon Tester (D-MT) in the Senate, and Morgan Griffith (R-VA) and Peter Welch (D-VT) in the U.S. House, which would curtail the ability of PBMs to extract retroactive direct and indirect remuneration (DIR) fees in transactions with patients, long term care (LTC) pharmacies and the Medicare program.
“2017 is unfolding badly for PBMs, which are now finally being forced to account for the deceptive means by which they siphon resources from patients, LTC pharmacies and the Medicare program itself,” concluded Rosenbloom. “SCPC will continue to shed light on anti-competitive PBM pricing practices, and their false claim that the pricing methodology used to reimburse LTC pharmacies for prescribed generic drugs is market-based when, in fact, they clearly are not.”
The SCPC is the national association for independent LTC pharmacies. Our member pharmacies provide care and services to patients in LTC facilities in across the country occupying approximately 675,000 beds across the country. Visit us at www.seniorcarepharmacies.org to learn more.