Pharmacy Policy, August 2024

FTC Intends to Sue Biggest Pharmacy Benefit Managers for Unfair Negotiating Tactics

The federal trade commission (FTC) is preparing to sue the 3 biggest pharmacy benefit managers (PBMs) for their role in negotiating unfair drug prices for patients and driving up the prices of key drugs such as insulin, the details of which were released in an interim report by the commission, according to multiple sources.^1-5

Image credit: chaynam | stock.adobe.com

CVS Health’s Caremark, The Cigna Group’s Express Scripts, and UnitedHealth Group’s OptumRx are some of the largest health care firms in the country; these 3 firms are poised to be challenged by the FTC in court for their allegedly unfair business practices.³

In a statement regarding the interim report, the National Community Pharmacists Association (NCPA) called for continued investigations and federal action, saying the report “should leave no doubt that these massive health care conglomerates are creating unfair advantages for themselves that are driving up costs for consumers, limiting consumer choices, and killing access to quality pharmacy care.”⁴

B. Douglas Hoey, MBA, RPh, CEO of NCPA, has praised the release of the interim report and called for “definitive action” to rein in the practices of PBMs, saying “the FTC must continue its investigation and pursue the information that the PBMs have so far defiantly withheld. Patients and community pharmacies need this fight to be finished, and need it urgently.”⁴—Luke Halpern, Assistant Editor

References

1. Whyte LE, Matthews AW. FTC to sue drug managers over insulin prices. The Wall Street Journal. Updated July 10, 2024. Accessed July 11, 2024. https://www.wsj.com/health/pharma/ftc-to-sue-drug-managers-over-insulin-prices-b46af71f?st=edj2se1di4w1fz9&reflink=desktopwebshare_permalink

2. Halpern L. FTC report acknowledges impact pharmacy benefit managers have on cost, accessibility of prescription drugs. Pharmacy Times. July 9, 2024. Accessed July 11, 2024. https://www.pharmacytimes.com/view/ftc-report-details-impact-pharmacy-benefit-managers-have-on-cost-accessibility-of-prescription-drugs

3. Roush T. FTC will sue pharmacy middlemen over inflated insulin prices, report says. Forbes. Updated July10, 2024. Accessed July 10, 2024. https://www.forbes.com/sites/tylerroush/2024/07/10/ftc-will-sue-pharmacy-middlemen-over-inflated-insulin-prices-report-says/

4. Scathing FTC interim report on PBMs warrants further investigations, immediate action by policymakers and regulators. News release. National Community Pharmacists Association. July 9, 2024. Accessed July 11, 2024. https://ncpa.org/newsroom/news-releases/2024/07/09/scathing-ftc-interim-report-pbms-warrants-further-investigations

5. Sisco J. Feds poised to sue pharmacy gatekeepers over high drug costs. Politico. Updated July 10, 2024. Accessed July 11, 2024. https://www.politico.com/news/2024/07/10/ftc-pharmacy-insulin-drug-00167342

PrEP Medicare Coverage Transition Has Implications for Pharmacies

The centers for medicare & Medicaid Services (CMS) has released pharmacyspecific information regarding the upcoming national coverage determination (NCD) for pre-exposure prophylaxis (PrEP) to prevent HIV.¹ Expected to be effective in late September 2024, the NCD aims to shift Medicare coverage for PrEP products from Part D to Part B.² This change will impact how pharmacies administer and bill for these essential products in the fight to end the HIV epidemic.

Under the NCD, pharmacies will be able to bill for both oral and injectable PrEP products. CMS also anticipates that some pharmacies may dispense injectable PrEP to a physician or other health care provider for administration. However, CMS does not address how pharmacists will be reimbursed for counseling on or administration of PrEP, even though in some states, pharmacists are authorized to provide long-acting injectable medications, including PrEP.¹

Pharmacists should prepare now for this transition by familiarizing themselves with the new billing codes and ensuring proper enrollment. By staying proactive, pharmacists can ensure the seamless integration of PrEP billing processes, thus getting this crucial preventive care to patients effectively and efficiently.—Spreeha Choudhury, PharmD, JD

References

1. PrEP for HIV national coverage determination. Centers for Medicare and Medicaid Services. Accessed July 18, 2024. https://www.cms.gov/files/document/faq-prep-hiv-06242024.pdf

2. Preexposure prophylaxis (PrEP) using antiretroviral therapy to prevent human immunodeficiency virus (HIV) infection. Centers for Medicare and Medicaid Services. Accessed July 18, 2024. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?NCAId=310

Post Roe, How Safe Are Period-Tracking Smartphone Apps?

Following the US Supreme Court's overturning of Roe v Wade in 2022, those advocating for privacy warned women and other individuals against using smartphone applications that track menstrual cycles. The warning was made because of concerns that the data collected from users would put them at risk of prosecution in states where abortion became illegal. More than 2 years later, women in the US continue to remain hesitant about their privacy when using these apps; however, some women are taking steps to ensure their protection.¹

According to survey results, nearly one-third of women in the US reported using apps to track their menstrual cycles, plan and prepare for menstrual symptoms, and identify the days they are most fertile. It is important to note that period-tracking apps are not covered under federal data privacy laws—including the Health Insurance Portability and Accountability Act—and there is no law that prevents private companies from sharing user information with third parties (eg, advertisers or insurance companies) or sharing it with law enforcement.¹

Although some participants may resort to deleting the app, doing so doesn’t necessarily make the data disappear from the developer’s servers or stop it from being shared and sold. In some instances, companies continue to store that data for years, long after a consumer stops using the app.1 To help mitigate these concerns, the study authors call on period-tracking app companies to be transparent about what data they are recording, and whether it is being shared with outside parties. The authors also note that future work can evaluate the privacy implications of integrating artificial intelligence chatbots, such as ChatGPT, into period-tracking and other health care apps.^1,3—Gillian McGovern, Assistant Editor

References

1. Data privacy in the post-Roe era: many women still concerned about privacy on period trackers, but few take action. Duke University. May 8, 2024. Accessed July 16, 2024. https://today.duke.edu/2024/05/data-privacy-post-roe-era

2. Sorkin AR, Giang V, Gandel S, Hirsch L, Livni E, Gross J. Reconsidering privacy risks after Roe. The New York Times. June 30, 2022. Accessed July 16, 2024. https://www.nytimes.com/2022/06/30/business/dealbook/abortion-privacy-risks-data.html

3. Cao J, Laabadli H, Mathis CH, Stern RD, Emami-Naeini P. “I deleted it after the overturn of Roe v Wade”: understanding women’s privacy concerns toward period-tracking apps in the post Roe v. Wade era. Presented at: CHI: Conference on Human Factors in Computing Systems; May 11-16, 2024; Honolulu, HI. doi:10.1145/3613904.2642042