September 5, 2012

Whose Practices Are ‘Opaque?’ PBM Lobby Attacks
Independent Pharmacies

Alexandria, VA—A document released by the pharmacy benefit manager trade group and quoted by some major news organizations is a “distorted re-hashing” of some recent events and reports, according to the National Community Pharmacists Association.

The report from the Pharmaceutical Care Management Association claims that recent Congressional hearings and government investigations “have raised serious questions about opaque business practices and pricing strategies within the independent drugstore industry.” It further states that “independent drugstores are significantly more prone to improper behavior than other pharmacies.”

In its blog, NCPA offered a sharp response to those criticisms. “For the PBM lobby to criticize independent community pharmacies for what PBMs claim are ‘opaque business practices and pricing strategies’ is the height of hypocrisy, akin to the pot calling the kettle black,” according to a recent blog post.

“PBMs spend vast resources intended to thwart any meaningful regulation and oversight of a secretive business model that has enabled them to mushroom from simple claims administrators to billion-dollar middlemen.”

PCMA takes issue with H.R. 4215, introduced earlier this year by Rep. Cathy McMorris-Rodgers (R-WA), which requires sponsors of a Medicare Part D prescription drug plan to inform pharmacies about how the plan’s “maximum allowable cost” reimbursement limits are set, to update pricing information weekly, and ensure that pharmacies are notified promptly of pricing changes. The legislation also limits audits of pharmacies carried out by Part D plan sponsors or their designees, only allowing prescription claims to be overturned if intent to commit fraud can be proven or a resulting increase in cost to the plan can be established.

“The bipartisan pharmacy audit fairness legislation NCPA supports, H.R. 4215, is based on a straightforward principle: When a pharmacist dispenses the right medication to the right patient at the right time, as prescribed by a doctor, it should not be a punishable offense,” according to the blog post. “That’s why more than 20 states have enacted pharmacy audit fairness legislation. These bills allow for audits against true fraud and abuse. What they deter are abusive audit practices that appear intended primarily to generate revenue for the middleman.”

PCMA maintains, however, that “some suggest that independent drugstores may need more, not less, accountability.”

The lobbying group also raised questions about whether community pharmacists are taking advantage of drug shortages and creating roadblocks to efforts to stem diversion of controlled substances.

The PCMA blog calls those claims “highly misleading.” NCPA Senior Vice President of Government Affairs, John Coster, PhD, RPh, testified at a congressional hearing on drug shortages recently and said that most of the pharmacies participating in the gray market for drugs in short supply were set up for that purpose and are pharmacies in name only.

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