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NACDS lauds CMS letter challenging PBM and health plan tactics

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ARLINGTON — NACDS is welcoming a proactive move by the Centers for Medicare & Medicaid Services (CMS) to outline increasing concerns about certain practices by some plans and pharmacy benefit managers (PBMs) that “threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers,” and to encourage plans and PBMs to work with providers and pharmacies to alleviate these issues and safeguard access to care.

NACDS logoCMS Administrator Chiquita Brooks-LaSure, Principal Deputy Administrator Jonathan Blum, and other members of the CMS leadership took this action in the form of a letter released today.

Read the CMS Letter

The CMS letter states: “We urge plans and PBMs to engage in sustainable and fair practices with all pharmacies – not just pharmacies owned by PBMs – and we are closely monitoring plan compliance with CMS network adequacy standards and other requirements.”

NACDS President and CEO Steven C. Anderson released the following statement about this move by CMS:

“NACDS – which represents regional pharmacy chains with as few as four stores and chains that operate nationally – thanks the CMS leadership for stating publicly and powerfully the jeopardy facing Americans, their pharmacies, and their communities as a result of pharmaceutical benefit manipulation by prescription-drug middlemen.

“The tactics of market-dominant middlemen have pushed pharmacies of all types and sizes to breaking points that can only inflict negative consequences on the Americans who rely on trusted and convenient access to medications and to pharmacy services.

“NACDS validates and appreciates CMS’ concerns in no uncertain terms.

“In addition to ensuring compliance with existing laws and regulations, NACDS urges total resolve in the all-branches and all-levels of government work that is making progress and that is underway to bring about urgently needed PBM reforms. The federal and state governments need to continue to perform their roles – in legislation, regulation, implementation, oversight, and legal defense of PBM reforms that put Americans first.

“Federally, NACDS urges Congress to finish the job on the bipartisan Medicare and Medicaid reforms that have been passed by the Senate Finance Committee, by the full House of Representatives, and by the House Energy and Commerce Committee. Congress needs to stand strong in the face of PBMs’ efforts to needlessly complicate, delay, undermine, and block reforms.

“It is imperative to recognize any distortions by the PBMs as last-ditch attempts to preserve their soaring profits and revenues. Estimates indicate that the PBM industry started this decade at $200 billion in annual revenue, and they are projected to conclude the decade at $800 billion in annual revenue.”


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