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April 29, 2015
Community Pharmacies Strained by Skyrocketing
Generics Prices Alexandria, VA—Burgeoning costs of generic prescription drugs are threatening patient access to the medications and to community pharmacies, which, because of inadequate reimbursement, increasingly can’t afford to fill them, according to a new survey. The survey of 700 community pharmacists was conducted recently by the National Community Pharmacists Association (NCPA). “For decades, community pharmacists have promoted the appropriate use of generic drugs to lower costs,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “However, more recently the price for some of these medications has skyrocketed 1,000 percent or more virtually overnight while reimbursement rates paid to community pharmacists have inexcusably lagged behind for weeks or months.” Among the survey’s key results: • About 80% of respondents said they had experienced “a large upswing” in the acquisition costs of generic drugs in at least 26 instances over the last six months; • The vast majority, 93%, said the situation had worsened since a previous NCPA survey in 2013; • Most pharmacists responding, 87%, said it took one month or longer for reimbursement rates—often “maximum allowable costs” (MACs)—to be updated by the insurance plan’s pharmacy benefit manager (PBM) to reflect market costs. • Nearly all of the survey responses, 92%, said the problem of slow MAC updates has deteriorated since 2013 and that appeals to update reimbursement benchmarks are typically denied or ignored by the PBM. Asked to cite specific drugs and instances of below-cost reimbursement, the respondents most commonly mentioned the following: benazepril; clomipramine; digoxin divalproex; doxycycline; budesonide; haloperidol; hydroxychroloquine; levothyroxine; methylphenidate; morphine; nystatin/triamcinolone; pravastatin; tamsulosin; and tizanidine. “This survey finds that this problem has only grown more severe over the past two years and requires urgent attention from federal and state policymakers,” Hoey added. “Community pharmacies cannot be expected to continually fill many prescriptions at a significant loss. Ultimately patients are impacted as well. Some patients are already skipping medication due to higher prices and copays or are forced into the Medicare coverage gap or 'donut hole' sooner. Others will likely find it more difficult to find certain generic drugs at all because their pharmacy can no longer afford to stock and dispense them.” The NCPA also reported that bipartisan legislation to mitigate the problem has been introduced by Reps. Doug Collins (R-GA) and Dave Loebsack (D-IA). The MAC Transparency Act, H.R. 244, would apply to Medicare Part D, the military’s TRICARE program and the Federal Employees Health Benefits Program (FEHB) and would require MAC benchmarks to be updated every seven days to better reflect market costs and allow pharmacists to know the source by which such benchmarks are set. In response to NCPA’s concerns, the Centers for Medicare & Medicaid Services issued a final rule in May 2014 to require price updates in Medicare Part D every 7 days starting in 2016. |
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