National LTC Pharmacy Advocacy Group Praises Grassley, Wyden Call for PBM “Spread Pricing” Probe

DATE: April 11, 2019

Washington, DC –The Senior Care Pharmacy Coalition (SCPC) today praised Senate Finance Committee Chairman Charles Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) for asking the U.S. Department of Health and Human Services (HHS) to probe the controversial pharmacy benefit manager (PBM) practice of “spread pricing” whereby PBMs charge one amount to health plans for a drug, then reimburse pharmacies a lower amount — and pocket the difference.

“We’re pleased by the activist investigatory approach taken by Senators Grassley and Wyden,” said Alan G. Rosenbloom, President of SCPC, the only federal advocacy organization devoted exclusively to the interests of the nation’s LTC pharmacies and the patients they serve. “When it comes to addressing the tangled web of opaque drug pricing transactions that undermine consumers, taxpayers and America’s health care system at-large, spread pricing is a ripe target for investigation.”

Rosenbloom pointed out that Bloomberg News has previously reported that PBMs have taken large markups in Medicaid plans. For many commonly prescribed generic medications, state insurance plans are paying millions in fees to PBMs, Bloomberg’s analysis found.

The SCPC leader lauded the efforts of Ohio Attorney General Dave Yost in seeking repayment of millions in public funds related to PBM OptumRx’s deceptive administration of the state’s Medicaid managed care program. Yost suggested to Bloomberg the complexity of the pricing practices and the system itself in this Ohio instance is designed to deceive: “I am concerned that it is internally complex and that it may be for the purposes of deception.”

Rosenbloom said that while sweeping reforms along the entire prescription drug supply chain are an SCPC priority, he warned the Senate Finance Committee yesterday that significant PBM financial losses that may occur in the aftermath of reform must not be “cost-shifted” to LTC pharmacies. He detailed four drug pricing reform policy recommendations to help ensure this does not occur.

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The Senior Care Pharmacy Coalition (SCPC) is the only national organization exclusively representing the interests of LTC pharmacies. Its members operate in all 50 states and serve 850,000 patients daily in skilled nursing and assisted living facilities across the country. Visit seniorcarepharmacies.org to learn more.