NCPA Endorses Bill That Would Bring Greater Transparency to Medicare Part D Generic Drug Payments
Targeted News Service |
Shortly after
"Generic prescription drugs account for approximately 80 percent of drugs dispensed, but the reimbursement system for these medications is a mystery to pharmacists and raises questions as to whether
"The cost for many generic drugs is soaring overnight yet PBMs in some instances wait months to update payment rates to reflect market realities--and rarely do so retroactively," Hoey added. "At the same time nothing prevents PBMs from billing
Reps. Collins and Loebsack have also put out a press release further explaining their rationale for introducing H.R. 4437.
Rep. Collins said: "A pharmacist often must provide crucial, very personal reassurance to their customers. A pharmacist can't provide certainty to a patient if they're operating with this kind of uncertainty about how much they'll have to pay for their stock. This is something we can do to create transparency and fairness in how prescription drugs reach customers--our constituents."
Rep. Loebsack added, "I have personally met with many
The contracts independent community pharmacies sign with PBMs for access to their pharmacy networks are non-negotiable and do not disclose the terms and conditions regarding payments for most generic drugs. Increasingly, pharmacies are being paid below their costs to dispense and the reimbursement limits, or Maximum Allowable Cost (MAC), is not updated frequently to reflect generic drug price spikes of 1000% or more. The legislation would allow a pharmacy to know how its individual MAC rates would be determined (but not those of other pharmacies in that particular health plan's pharmacy network) and require payments to be updated more frequently to keep pace with actual market costs.
By reimbursing pharmacies at low rates and charging health plans at much higher rates--a practice known as "spread pricing"--the PBMs generate enormous profits while propping up insurance costs for employers, government agencies and consumers. H.R. 4437 could reduce the cost of such PBM spread pricing and would also establish an appeals process for pharmacies to resolve disputes over drug reimbursement. A recent
Legislation similar to H.R.4437 has been enacted on a bipartisan basis in nine states over the past two years.
[Category: Pharmaceuticals]
TNS 18EstebanLiz-140411-30FurigayJane-4700101 30FurigayJane
Copyright: | (c) 2014 Targeted News Service |
Wordcount: | 679 |
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News