ALEXANDRIA, Va. — Eleven congressmen have asked the Centers for Medicare & Medicaid Services (CMS) for information on the enforcement of transparency measures for generic drug payments in Medicare Part D plans for 2016.
The National Community Pharmacists Association said Thursday that this week U.S. Reps. Rick Allen (R., Ga.), Rod Blum (R., Iowa), Buddy Carter (R., Ga.), Doug Collins (R., Ga.), Morgan Griffith (R., Va.), Walter Jones (R., N.C.), Dave Loebsack (D., Iowa), John Sarbanes (D., Md.), Austin Scott (R., Ga.), Peter Welch (D., Vt.) and Lynn Westmoreland (R., Ga.) sent a letter to CMS acting administrator Andrew Slavitt requesting more details on how the transparency provisions will be upheld.
NCPA noted that transparency provisions for pricing based on maximum allow costs (MAC) were included by CMS in its final rule issued in May 2014, but the regulatory framework for the implementation of such provisions hasn’t yet been released.
“Generic prescription drugs account for over 80% of drugs dispensed, but details surrounding the reimbursement system for these medications are unknown to pharmacists and raise serious questions as to whether Medicare is overpaying the plan drug middlemen, pharmacy benefit managers (PBMs),” the representatives said in the letter.
They pointed out that while pharmacists are reimbursed for generics through MAC lists, those lists may not be updated regularly, often resulting in below-costs reimbursements — especially in the wake of recent price spikes in generic medications.
“As you begin preparing to enforce these provisions, please share with us your plans to ensure ordered implementation. Many states have passed MAC transparency laws and have struggled to enforce them effectively,” the lawmakers added.
Also highlighted in the letter is the MAC Transparency Act (H.R. 244), a MAC reform bill pending in the House of Representatives. The legislation, introduced by Collins and Loebsack, presents a possible framework for additional measures that can be implemented for greater fairness in generic drug pricing and transparency, according to NCPA.
“Independent community pharmacies have struggled to remain financially viable due to the discrepancy between the soaring acquisition costs for many generic prescription drugs and the outdated and low reimbursements they receive from pharmacy benefit manager (PBM) corporations. That’s why we were heartened when CMS made a commitment to not only ensure generic drug reimbursements are updated by PBM corporations on a weekly basis to reflect market prices, but also to provide information as to how those reimbursements are determined for Medicare Part D next year,” NCPA CEO B. Douglas Hoey said in a statement.
“Needed guidance from CMS that will determine how PBM corporations must follow these new requirements is still pending, which is why a bipartisan coalition from the U.S. House of Representatives took the opportunity to remind CMS why this change is badly needed,” Hoey added. “NCPA appreciates their support, because the unfortunate ‘buy high/sell low’ dynamic is not sustainable. But most importantly, by creating a fairer reimbursement system, independent community pharmacies can focus more on what they do best: serve patients.”