To Boost Transparency, SCPC Seeks to Amend Senate, House Bills to Require PBM Disclosure Data Related to Seniors Residing in LTC Facilities

DATE: January 29, 2020

Washington, DC – To better ensure the Centers for Medicare and Medicaid Services (CMS) and consumers have access to drug pricing information relevant to seniors residing in long term care (LTC) facilities, the Senior Care Pharmacy Coalition (SCPC) today suggested that 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) data.

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,” stated Alan G. Rosenbloom, President and CEO of SCPC. “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, Congress chose to prohibit CMS from sharing any of the reported information, even in aggregate form, with consumers and the public,” Rosenbloom continued. “SCPC believes sharing this data and increasing transparency in this manner is beneficial to seniors, consumers and the public-at-large.”

The SCPC leader also said 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, Rosenbloom pointed out there is not an explicit provision for separate reporting of LTC pharmacy data. “Therefore, CMS, LTC residents and the pharmacies that serve them do not have access to the different drug pricing data that governs this segment of the prescription drug market – but would be better served if they did.”

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