PCMA releases statement regarding the Senate Finance Committee’s ongoing deliberations on health-care reform

Pharmaceutical Care Management AssociationSep 24 2009

Mark Merritt, President & CEO of the Pharmaceutical Care Management Association (PCMA) released the following statement regarding the Senate Finance Committee’s ongoing deliberations on health-care reform:

“As the Senate Finance Committee continues to craft legislation, the next 48 hours will be critical in determining whether health reform delivers on the promise of making prescription drugs more affordable for all Americans. With nearly $245 billion spent annually on prescription drugs, Americans want the peace of mind that comes from knowing that reform makes common-sense improvements that lower the cost of prescriptions for everyone.

“Over the past decade, America’s pharmacy benefit managers (PBMs) have been at the nexus of a quiet revolution that has put the brakes on runaway prescription drug costs for consumers, Fortune 500 employers, and government programs. PBMs are hired by unions, large employers, and Medicare to be tough negotiators against drug companies, chain drugstores, and independent pharmacies – and PBMs are delivering. From 1999-2009, the annual rate of growth in prescription-drug spending has declined by a projected 78 percent, according to the Centers for Medicare and Medicaid Services (CMS). For seniors, PBMs have played a critical role in expanding access to a wide range of safe and effective drugs, while reining in the cost of Medicare Part D to 40 percent less than originally estimated. PBMs have employed an array of tools to combat rising drug costs, including more competition generated through formularies, expanded use of mail-service pharmacies, and a greater reliance on generic drugs.

“While PBMs have helped spearhead important progress, in the coming 48 hours the Senate Finance Committee has the opportunity to do more to make prescription drugs more affordable, including:

• Expand seniors’ mail-service pharmacy options. While numerous independent studies have documented that mail-service pharmacies reduce drug costs and provide greater safety and convenience, Medicare beneficiaries are not given the same incentives to use this proven delivery system as the under-65 population. Congress would help seniors – and taxpayers – save billions if health reform expands seniors’ access to chronic care medications delivered through mail-service pharmacies.
• Promote more competition in Medicare by requiring brand-name drugmakers to negotiate on all Part D drugs. Regrettably, Medicare Part D insulates drugmakers from competition by requiring drug plans to cover “all of substantially all” drugs in at least six different drug classes, despite no evidence that patients have had difficulty accessing these drugs. In doing so, this provision merely allows brand-name drugmakers to charge higher prices because they know plans are required to include their drugs on formularies, whether they offer discounts or not. According to CMS, removing this pharma-friendly requirement would save Medicare $4.2 billion over ten years.
• Sustain the proven PBM delivery model that has lowered costs and expanded access. By negotiating against the drugmakers and drugstores on behalf of consumers and payers, PBMs have helped payers level the playing field in the prescription-drug marketplace. The record of PBMs in helping to drive down costs over the past decade, both in the commercial marketplace and in Medicare, is testament to this record. PCMA believes it is critical that the Senate Finance Committee sustain this proven delivery model and resist proposals – including “one-size-fits-all” disclosure requirements – that would empower drugmakers and drugstores to use proprietary pricing information to charge higher prices.
• Address the biotech cost-crisis through real biogenerics reform. While not under the jurisdiction of the Senate Finance Committee, legislation creating a workable and meaningful biogeneric pathway is essential to curb the skyrocketing cost of biotech medicines. Like the White House, PCMA believes that offering seven additional years of ‘market exclusivity’ to the handful of companies who make biologics would be ‘generous.’

“In addition, PCMA is encouraged that the Senate Finance Committee legislation would allow seniors enrolled in Part D to receive free generic drugs on their first fill of a prescription. Providing free generics to seniors on their first prescription fills encourages them to choose cost-effective generic medications over more expensive brands.”