IMF Helps Launch Coalition for PBM Reform

IMF-The Food Industry Association has joined forces with five other industry organizations to form a watchdog group overseeing Pharmacy Benefit Managers (PBMs).

Called on Coalition for PBM Reform, the group aims to bring more transparency to what its members consider to be anti-competitive and “opaque” business practices of PBMs. The coalition – whose participants include doctors, pharmacies, retailers, healthcare and small business groups and patient advocates – cites “underwater” reimbursements, patient piloting and other practices questionable PBMs as restricting patient access and increasing costs.

Related: IMF and NGA join pharmacy coalition supporting DIR fee reform

Announced yesterday, the founding members of the Coalition for PBM Reform include the National Community Pharmacists Association (NCPA), the FMI-The Food Industry Association (FMI), the AIDS Healthcare Foundation (AHF), the National Federation of Independent Businesses (NFIB), Coalition of State Rheumatology Organizations (CSRO) and Community Oncology Alliance (COA). These groups describe the new coalition as “the largest and most diverse effort to date” to change the way PBMs operate, as their constituents include independent pharmacies, grocery stores, small businesses, health care providers. health and patients.

“Our member’s retail stores include 10,000 supermarket pharmacies offering a full line of health and wellness tools that are so important to our customers. Unfortunately, despite their critical role during the COVID-19 pandemic, supermarket pharmacies are struggling to stay in business due to anti-competitive practices by PBMs, ”IMF Chairman and CEO Leslie Sarasin said in a statement. communicated. “We look forward to working with the diverse group of organizations that make up the Coalition for PBM Reform to collectively seek greater transparency in the operation of PBMs, which will benefit patients, healthcare providers, to employers and pharmacies. “

Related: Podcast: Hy-Vee’s Mike Agostino Says Transparency Is Key To New PBM

According to the Coalition for PBM Reform, PBMs are part of the health system “dominated by a few corporate intermediary giants” and whose practices are largely uncontrolled.

“Our organizations represent millions of patients, hundreds of thousands of employers and thousands of healthcare providers whose access to medicines is threatened by a handful of companies that dominate the prescription drug industry,” the coalition said in a statement. “These companies decide on prescription drug benefits, set prices, limit access and threaten the viability of local health care providers. Plus, they do this without treating or counseling a single patient and without providing insurance coverage to a single employee or family. “

The country’s three largest PBMs – Caremark (CVS Health), Express Scripts / Ascent Health Services (Cigna) and OptumRx (United Health) – control nearly 80% of all filled drug prescriptions in the United States and are among the Fortune 15 companies, the coalition is noted.

“Because they work for the largest insurance plans, public and private, their practices affect the cost of prescription drugs for most Americans and most employers. Nonetheless, they operate well out of the public eye. In fact, the terms they place on patients, providers and employers are negotiated without any oversight, ”said the Coalition for PBM Reform. “Transparency and information are the keys to any healthy market. They are the basis on which consumers can make decisions. These elements are largely absent from the prescription drug market, and this coalition aims to change that. “

One of the main concerns of PBM reformers is the direct and indirect (DIR) remuneration costs of pharmacies. DIR fees refer to the post-point-of-sale compensation received by PBMs and Medicare Part D plan sponsors for prescription drugs. Used in the calculation of Medicare final payments to Part D plans, these fees are primarily discounts paid by drug manufacturers, but also include concessions paid by pharmacies, such as pay-for-performance network fees. and reimbursement reconciliations. As a result, DIR charges affect the final cost of a drug to payers and the price paid to pharmacies for a drug.

The lack of transparency of these costs and the fact that they are often billed retroactively, after the point of sale for medicines dispensed to the elderly under Part D. All sizes have felt the financial pressure, especially the small ones. operators.

Last spring, IMF joined with other trade groups in the retail and pharmacy industry to approve new federal legislation to tighten the regulation of escalating DIR fees. The bill, entitled Pharmacy DIR Reform to Reduce Senior Drug Costs Act (S. 1909 / HR 3554), was introduced in late May in the Senate by Sense Jon Tester (D-Mont.) And Shelley Moore Capito (RW.Va .) and in the House by Representatives Peter Welch (D-Vt.) and Morgan Griffith (R-Va.).

In addition to IMF and NCPA, organizations expressing support for the bill include the National Grocers Association (NGA), the National Association of Chain Drug Stores (NACDS), the American Pharmacists Association (APhA), the National Alliance of State Pharmacy Associations (NASPA), National Association of Specialty Pharmacy (NASP) and American Society of Consulting Pharmacists (ASCP).