Pharmacists Urge Feds to Support Pharmacy Choice, Transparency for Health Insurance Exchanges

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Alexandria, Va. - August 8, 2011

Patients and health plans participating in multi-state health insurance plans offered through the exchanges should enjoy the benefits of a robust and competitive pharmacy marketplace as well as common-sense disclosure requirements for pharmacy benefit managers (PBMs), the National Community Pharmacists Association (NCPA) said in the form of recommendations in comments with the U.S. Office of Personnel Management (OPM). OPM is responsible for contracting with at least two multi-state plans that will offer coverage through exchanges, which come online in 2014, and will provide consumers with additional health insurance options.

"Successful health care reform places a premium on transparency, and nowhere is that needed more than in the administration of prescription drug services by the PBM industry," said B. Douglas Hoey, RPh, MBA, NCPA executive v ice president and CEO. "The federal health reform law includes just such a provision in the state health care exchanges. These disclosure requirements allow health plan sponsors to actually ensure PBM promises of efficiency and savings are occurring. It also will help prevent the $371 million in legal settlements that have been paid out by PBMs to address allegations of questionable practices."

Hoey added, "This approach should be extended to all health plans, and other PBM reform bills such as The Pharmacy Competition and Consumer Choice Act (S. 1058/H.R. 1971) and The Preserving Our Hometown Independent Pharmacies Act (H.R. 1946) should also be enacted."

NCPA's comments to OPM included the following specific recommendations:

  • OPM should include PBM transparency requirements in any forthcoming proposed requirements that are consistent with proposed HHS regulations on health insurance exchanges.
  • OPM should implement the PBM transparency provisions that the agency recently instituted for the Federal Employees Health Benefit Plan (FEHBP) in the multi-state exchange plans.
  • In order to ensure adequate access to pharmacy services in hard-to-serve regions, OPM should allow participation of "any willing pharmacies" in multi-state exchange plans.
  • In terms of pharmacy network adequacy, OPM should not equate access to mail order pharmacy with access to face-to face interaction with a pharmacist.
  • OPM should require qualified health plans in multi-state exchanges to include an annual pharmacist-provided comprehensive medication review as a quality improvement strategy.

Hoey concluded, "These common-sense solutions will allow independent community pharmacists to play a greater role in reducing costs and improving outcomes through the appropriate utilization of generic drugs and effective face-to-face counseling to ensure that patients take their medication as directed by their doctors. If enacted, the previously uninsured or under-insured Americans who will get their prescription drug benefit through these state health care exchanges will stand to benefit the most."

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies, pharmacy franchises, and chains. Together they represent a $93 billion health-care marketplace, have more than 315,000 employees including 62,400 pharmacists, and dispense over 41% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com.

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