PBMs Want To Distribute New Rebate Payments; Pharmacists Disagree

DATE: April 12, 2019

Published by Inside Health Policy

The Trump administration’s point-of-sale rebate proposal would drastically alter the way rebates are delivered, and pharmacy benefit managers are angling for responsibility to distribute the rebates under the new model. PBMs have signaled they could sue the administration if they don’t like the way the final rebate rule is structured. Pharmacists, on the other hand, want an entity other than PBMs to fill the intermediary role between manufacturers and pharmacies.

Currently, PBMs pay pharmacies for drugs, then they get rebates from drug makers that are passed to plans, though PBMs often keep some of the rebates. Under the new rebate proposal, drug makers would pay the rebates, directly or indirectly, straight to the pharmacies.

The HHS Office of Inspector General uses the term “chargeback” to describe these new payments, even though the word is already an established term of art for payments between manufacturers and wholesalers, said CiiTA Managing Director Jason Hardaway.

In comments to the administration, the PBM lobby made clear that it was strongly opposed to the point-of-sale rebate proposal and argued the government does not have authority to make the regulatory changes. However, if the proposal were implemented, the group wants changes that would let PBMs act as intermediaries to distribute the rebate payments to pharmacies.

The Pharmaceutical Care Management Association said PBMs are best suited to continue acting as middlemen if the new system is implemented. Funneling rebates to the point of sale would require a new payment system, and pharmacists would need more data than they currently use to calculate patient costs, the PBM lobby said. PCMA argued that PBMs already have the infrastructure to work with major health care systems, plans and pharmacies; they have the information necessary to inform point-of-sale price calculations for beneficiaries; and building a new model from scratch would be costly and time-consuming.

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