The Top Six Ways Trump’s Policies Will Impact Pharmacies
We're still within the first 100 days of a new administration. What is happening, and what can you expect?
3. Pharmacy benefit managers and remuneration fees
Any attempts to address rising drug costs must include the role that PBMs play in “extracting enormous profits from patients, payers, and pharmacies,” Hoey said. Direct and indirect remuneration (DIR) fees for the Medicare Part D program has “become the number one priority of independent community pharmacies over the last two years, and we were thankful that concerns we expressed to CMS [Centers for Medicare and Medicaid Services] and to members of Congress seem to have been taken into account,” NCPA said.
NCPA recommends that the Trump administration rely on CMS’s recent analysis, which found that DIR fees “do not reduce the cost of drugs for beneficiaries at the point of sale and tend to push seniors into the ‘donut hole’ or catastrophic phase of their coverage faster,” Hoey said. “CMS also asserted that Part D plans and PBMs favor using these post-point-of-sale price adjustments because it shifts their share of costsharing onto the beneficiaries and taxpayers.” CMS should finalize the ‘negotiated price’ guidance as proposed, to require fees be approximated at point-of-sale, and Congress should consider enacting bipartisan legislation to eliminate all retroactive pharmacy DIR fees or price concessions, Hoey said.
“We also would want the transparency provisions CMS established for Medicare Part D plans multisource generic prescription drugs under their maximum allowable costs (MAC) list to be maintained. Otherwise those hard-fought gains to provide more information about how the reimbursement criteria is established, and how frequently those reimbursement lists are updated could be an enormous setback,” Hoey stated.