National LTC Pharmacy Advocacy Group Asks CMS to Release “Summary Data” on PBM Medicare Spread Pricing Activity

DATE: June 27, 2019

Washington, DC – In a new letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, Senior Care Pharmacy Coalition (SCPC) President and CEO Alan G. Rosenbloom thanks CMS for its recent guidance curtailing pharmacy benefit manager (PBM) “spread pricing” in Medicaid, and now requests that CMS release appropriate “summary data” on PBM spread pricing in Medicare.

The complete text of the letter below:

Dear Administrator Verma:  

On behalf of the nation’s independent long term care (LTC) pharmacies, we are writing to thank you for issuing your agency’s recent guidance related to “spread-pricing” in Medicaid, and pharmacy benefit managers’ (PBMs) role in up-charging health plans and costs for state taxpayers. 

Now that CMS, under your leadership, has taken decisive action on Medicaid, we believe it is time to direct scrutiny at the Medicare side of the spread pricing ledger. There is little question the same PBM spread pricing practices you have documented in Medicaid are pervasive throughout the commercial and Medicare markets.

There also is little question that the spread pricing is equally pernicious in the Part D market, to the detriment of older Americans. In addition, independent LTC pharmacies increasingly must compete on an uneven field increasingly dominated by oligopolistic health care conglomerates.

These vertically integrated oligopolies commonly own health insurance companies and pharmacies that collectively dominate those markets (retail, specialty, mail-order and LTC), a dominance leveraged in significant part by questionable business practices of the PBMs that are the core of those companies.  

Bringing a comparable level of scrutiny, public accountability and data release pertaining to Medicare is the logical next step. Under current law, PDPs and PBMs must report Medicare spread pricing data to CMS. However, we recognize the law prevents CMS from sharing specific details with the public. 

Therefore, we respectfully request that CMS release this information publicly in “summary form.” We also request that CMS support amending the law to allow public disclosure of detailed Part D spread pricing data. Such disclosure would advance the Administration’s objectives of greater transparency, expanded consumer access and lower drug costs while supporting a more competitive marketplace for independent LTC pharmacies as well.

Failure to spotlight the truth surrounding PBMs’ Medicare abuses has the potential to create access and cost problems for consumers, undermine free and fair competition, and jeopardize small and local business owners’ ongoing economic viability. 

Sincerely,
Alan Rosenbloom
President and CEO
Senior Care Pharmacy Coalition

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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.