NCPA on Health Care Reform Implementation: Ensure Access to Community Pharmacies, Implement PBM Transparency Requirements


Alexandria, Va. - Oct. 4, 2010

As officials with the U.S. Department of Health and Human Services (HHS) work to implement key provisions of the Patient Protection and Affordable Care Act affecting the health care insurance exchanges, the National Community Pharmacists Association (NCPA) is urging the new HHS Office of Consumer Information and Insurance Oversight to safeguard patient access to community pharmacists' services and to ensure that regulations relating to transparency requirements for pharmacy benefit managers (PBMs) are effective.

In comments submitted to HHS, NCPA suggested that, in implementing the law's commitment to "ensure a sufficient choice of providers," HHS adopt minimum pharmacy access standards in the exchanges that are similar to government programs like the Medicare Part D and the military's TRICARE programs. In addition, NCPA argued against tiered co-payments that favor one pharmacy provider (such as mail order) over others and that any pharmacy willing to accept the terms of the pharmacy contract should be allowed to participate.

Citing the expanding preventative care role local pharmacists can play, such as through immunization and medication therapy management, NCPA recommended that HHS "encourage states to recognize and incorporate the emphasis on preventative care and collaborative care models expressed in Federal health care legislation as they establish provider networks. Inclusion of pharmacists in these activities and recognition of their expertise in safe and appropriate medication use can help to reduce costs and promote optimal patient outcomes."

The health care reform law requires PBMs operating in the health insurance exchanges to confidentially report the percentage of all prescriptions provided through retail pharmacies compared to mail order and the generic dispensing rate and substitution rates of each; the aggregate amount and types of rebates, discounts and price concessions that the PBM negotiates on behalf of the plan and the aggregate amount of these passed on to the plan sponsor; and the average aggregate difference between the amount the plan pays the PBM and the amount that the PBM pays the retail and mail order pharmacy.

"Access to this critical information will enable the Secretary and the health plans to better evaluate and in turn negotiate contracts for prescription drug benefit administration in order to contain costs and maximize consumer protections," NCPA said in its comments. "To date, there has been no clear direction as to where these new Federal PBM disclosure requirements should be included. In order to ensure that these mandated PBM transparency disclosures are communicated and implemented in a consistent and meaningful manner among all plans in each exchange, NCPA believes that federal exchange regulations must require that all exchange plans include the PBM transparency requirements in any contract into which they enter with a PBM."

The National Community Pharmacists Association (NCPA®) represents America's community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com.

Ask Your Family Pharmacist TM