NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every Friday.

PBMs: What They Say, What They Do, and What Can Be Done About It | NCPA Executive Update | April 7, 2017

by NCPA | Apr 07, 2017

Dear Colleague,

Doug Hoey

Pharmacy school was hard enough, but trying to explain some of our courses to non-science students was a buzz-kill, really. Fast forward past graduation and think about how difficult it is to explain the ins and outs of PBM practices, tactics, and general outrages to your patients and lawmakers.

Why try? Because we need them on our side if we are to make progress against the all-controlling, billion-dollar behemoths that dictate terms with community pharmacy. If non-pharmacists are to help us, they need a general understanding of what PBMs do and how they got here—an understanding that goes beyond that little insurance card in so many wallets.

In that vein, NCPA has produced a new resource for helping policymakers, patients, and the media know about the discrepancy between what PBMs say and the actual effect they have in driving up prescription drug prices and limiting patient access to medications. It's called The PBM Story: What They Say, What They Do, and What Can Be Done About It.

It's now available for download in either 6-page or 12-page formats on NCPA's website.

Please download and share it promptly with your members of Congress, your state legislators, other policymakers, local employers, and anyone else who needs to understand that there are better solutions that exist to address rising prescription drugs while still ensuring quality patient care.

When you read it, you may learn some things that aren't top of mind even to us "experts." Just think about how some humble, behind-the-scenes claims processors morphed into three giant corporations that now control 253 million American lives and 78 percent of all U.S. prescription drug benefit transactions. Middlemen on the march.

The booklet explains how PBMs make their money (rebates, administrative fees, and spread) and includes some mind-boggling charts on prescription drug benefit cost increases (1010 percent in less than 30 years), patients' actual out-of-pocket cost increases (169 percent since 1987), and PBM profits (spiking, like your blood pressure may when you see the chart).

Maybe some of your patients and lawmakers don't want to know how the clock was made, they just want to know what time it is. That's what The PBM Story does.

It is time for a change, and we explain what the change should be in our "prescriptions for what's ailing prescription health care costs in the U.S." section of the booklet.

Change starts with strengthening federal regulation of PBMs by enacting our three pro-patient, pro-pharmacy bills in Congress: Banning retroactive pharmacy DIR fees (S. 413/H.R.1038), MAC transparency (H.R. 1316), and patient pharmacy choice (H.R. 1939) and ends with unchaining the abilities of community pharmacies to help lower overall health care costs.

I look forward to talking with many of you at our Congressional Pharmacy Fly-In in Washington, D.C., April 26-27, where you'll not only get to discuss The PBM Story with your members of Congress and their staffs, but you'll also be able to ask for their support for our legislative agenda. Here's how to register. See you soon.

Doug Hoey

P.S.—Discover how some community pharmacists are lowering their patients' health care costs through enhanced services and provider collaborations in their pharmacies at the NCPA Innovation Center's Re-Engineering Your Pharmacy Boot Camp May 5-6 in the New York City area. The Boot Camp offers networking, in-depth training, and implementation support to help you develop enhanced services at your pharmacy. Reserve your spot now.