PCMA Statement on the Administration’s Proposed Medicare Part D Rule
"We share the Administration's goal of reducing prescription drug costs and increasing access to needed treatments for Medicare beneficiaries.
While we are reviewing the proposed rule, we are encouraged the Administration supports greater use of competitive pharmacy benefit manger (PBM) tools that strengthen Medicare Part D for beneficiaries and taxpayers. Specifically, the proposed rule increases formulary flexibility in the so-called 'protected classes' allowing for Part D plans to negotiate bigger discounts.
It is also encouraging that the Administration wants to increase transparency on real-time cost sharing for beneficiaries and doctors in Part D.
The Administration is considering for a future plan year changing how price concessions negotiated between pharmacies and PBMs are reflected in beneficiary cost sharing. These competitive negotiations generate significant savings for the federal government and beneficiaries, while also encouraging pharmacies to meet contractual 'pay-for-performance' standards based on quality measures such as generic dispensing rates.
We look forward to continuing to work with CMS to find ways to improve benefits and reduce costs in the Medicare Part D program."
PCMA is the national association representing America's pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.

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