A leading Democrat and health legislator is urging the Centers for Medicare & Medicaid Services (CMS) to better enforce Medicare Part D program requirements for pharmacy benefit managers.
By evading such requirements, PBMs are threatening the financial health of the country's smaller pharmacies, Senate Finance Committee Chair Ron Wyden, D-Oregon, wrote to the agency in a letter (PDF).
“I am alarmed to hear reports that PBM contracting practices are straining the finances of pharmacies and directly contributing to their closures,” he said. “Specifically, I am concerned PBMs are not adhering to the new rule reining in direct and indirect remuneration (DIR) fees that took effect on January 1 and undermining Medicare’s pharmacy access standards as intended by Congress.”
More than 300 independent pharmacies closed last year, including 35 in Wyden’s home state of Oregon. Broadly speaking on behalf of those pharmacists, Wyden said PBMs are paying pharmacies unfair contracting terms and subpar reimbursement levels, leaving pharmacies within a Part D network that does not fit their needs.
Express Scripts and CVS Caremark are the two PBMs overwhelmingly causing pharmacies the most headaches, according to a February 2024 physicians survey (PDF) conducted by the National Community Pharmacists Association.
“This is especially troubling given that Express Script’s Part D market share increased substantially as of January 1, particularly concerning dual-eligible Part D enrollees,” Wyden said. “Capitalizing on its growth in market share, Express Scripts seems to have expanded its use of predatory pricing behavior which has slashed pharmacy revenues to unsustainable levels.”
To stop these practices, Wyden wants CMS to enforce the “Any Willing Pharmacy” requirement that mandates PBMs reimburse pharmacies at least what prescription drugs cost to acquire and dispense. Additionally, he wants pharmacy price concessions be applied to prices at the point of sale, as a final rule indicates should already be in effect.
He is also looking for more information as to whether the number or types of complaints by pharmacies regarding PBM policies have increased in the last 18 months.
“The inflated drug prices that Americans pay, the barriers to pharmacy and medication access that they face, and the impossible terms forced on pharmacies—at the hands of the pharmaceutical middlemen—cannot be allowed to stand,” said National Association of Chain Drug Stores President and CEO Steven Anderson in a statement. “We applaud Senate Finance Committee Chair Ron Wyden for his ongoing commitment to delivering PBM reform.”