NCPA Discusses PBM Reform, DIRs

Pharmacy benefit managers (PBMs) are not subject to industry-wide regulation, and this lack of regulation may be contributing to increased drug spending, according to comments submitted by the National Community Pharmacists Association to the US Senate Health, Education, Labor and Pensions (HELP) Committee for its hearing, "The Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay, Part II."

NCPA officials highlighted how limited transparency adds cost to the system.

Drug manufacturer rebates and spread pricing are 2 areas where health plan sponsors may not have sufficient insight into these tactics. In addition, the reimbursement system for generic prescription drugs and direct and indirect remuneration (DIR) fees is distorted by the PBMs, purposefully keeping pharmacies in the dark about their compensation criteria in ways that also impacts patients.

In the case of DIR fees, which are the top concern of independent community pharmacies, NCPA's comments push for enactment of S. 413 / H.R. 1038. Those companion bills ban retroactive clawbacks that Medicare has concluded increase patient and federal government expenditures in Medicare Part D. In fact, a recent study indicates the legislation would save the federal government $3.4 billion over 10 years.

Learn more about these NCPA efforts on DIRs in this interview with Doug Hoey, RPH, MBA, which was held at the NCPA Annual Convention this week.