Under current statute, PBMs are required to report Medicare spread pricing data to CMS -- but the law prevents the agency from sharing details with the public.
"Any comprehensive 'spread pricing' solution requires disclosure and evaluation across all markets -- and the need to implement policies to rein in excessive spread pricing and undue use of disproportionate market power to benefit pharmacies that share common ownership with PBMs -- to the detriment of independent competitors," Rosenbloom concluded.
"While PBMs claim to keep drug costs low, community pharmacists believe their business practices are often anti-competitive and drive up health care costs for consumers while harming small-business pharmacies."
Among other things, the new law will require PBMs to allow local pharmacies to participate in any network, provided the pharmacies accept terms and conditions.
"This won't shut down PBMs. They'll still exist, but they'll have to compete on a level playing field and be more transparent," Echols said.
"This government overreach would restrict practices and tools PBMs use to reach optimal deals and savings, and could raise the cost of health plans," the ATR said.
* GDR is a DIR measure used by four of the seven PBMs and plans that assess DIR fees, but it is another example of a largely unattainable metric.
This is a difficult metric to monitor, as different PBMs and plans use varying brand/generic definitions and set different targets that pharmacies must reach.
* The complexity of managing DIR fees is compounded by the fact that pharmacies are expected to manage a different accrual calendar for seven different PBMs and plans.
Discount Transfer from PBMs to Third Party Payers 81
manufacturers with pharmacy benefit managers (PBMs) acting as important
Problematically, this structural and functional trait allows PBMs to