To boost transparency, amend bills to require PBM disclosure data related to seniors residing in long-term care facilities

DATE: February 12, 2020

McKnight’s Long–Term Care News – February 10, 2020

By Alan G. Rosenbloom

To better ensure consumers and the Centers for Medicare & Medicaid Services (CMS) have access to drug pricing information relevant to seniors residing in long term care facilities, we believe the Senate Finance Committee-introduced Prescription Drug Pricing Reduction Act (PDPRA) and the Lower Cost, More Cures Act of 2019 (S. 3129/H.R. 19), introduced by Sen. Mike Crapo (R-ID) and Rep. Greg Walden (R-OR), respectively, should be amended to require disclosure of relevant pharmacy benefit manager (PBM) pricing data.

Here’s the background: In 2010, Congress added Section 1150A to the Social Security Act (42 U.S.C. § 1320b-23) requiring PBMs to disclose to CMS certain dispensing, pricing and rebate information. Over time, this information from PBMs has proven invaluable to CMS understanding how drug pricing, rebates and discounts affect Medicare beneficiaries and other consumers at the pharmacy counter. This information has allowed the agency to provide policy updates to the public on how rebates and discounts affect federal spending.

Unfortunately at the time, however, Congress chose to prohibit CMS from sharing any of the reported information, even in aggregate form, with consumers and the public. Though it was just 10 years ago, those were significantly different times in the context of today’s complex, contentious drug pricing debate.

Quite simply, we believe the time has come to share this data. Increasing transparency in this manner will be beneficial to seniors, consumers and the public-at-large. The Senior Care Pharmacy Coalition also believes the bills could be improved by clarifying that PBMs and health plans should also separately report data involving Medicare beneficiaries and other consumers served by a LTC pharmacy — separate from other retail pharmacy data.

Although the law currently requires separate reporting by “pharmacy type” — which includes independent pharmacy, chain pharmacy, supermarket pharmacy or mass merchandiser pharmacy — there is no explicit provision for separate reporting of LTC pharmacy data. Thus, CMS, long-term care residents and the pharmacies that serve them do not have access to the different drug pricing data that governs this key, growing segment of the prescription drug market. They would all be better served if they did.

Alan G. Rosenbloom is president and CEO of Senior Care Pharmacy Coalition, the only national organization exclusively representing the interests of long-term care pharmacies.