Trumm Drug

October 2009 Drug News

• NCPA Applauds Senate committee’s vote to reduce health care costs by approving transparency requirements for Pharmacy Benefits Managers

Alexandria, Va. – September 25, 2009 The National Community Pharmacists Association (NCPA) today commended the U.S. Senate Finance Committee for approving by unanimous, voice vote an amendment by U.S. Sen. Maria Cantwell (D-WA) to lower health care costs through common-sense disclosure requirements for any pharmacy benefit manager (PBM) participating in the health insurance exchanges envisioned in Chairman Max Baucus’ (D-MT) America’s Healthy Future Act.

“PBMs routinely gobble up significant shares of nearly every prescription drug transaction, passing the costs on to patients and plan sponsors often left in the dark as premiums increase,” said Bruce T. Roberts, RPh, NCPA Executive Vice President and CEO. “Increasingly, public and private payers are rightly asking questions and demanding more equitable pharmacy benefit arrangements. Medicare, the Pentagon, state governments and major companies are all moving in this direction and today’s vote shows the Senate is, too. We commend Senator Cantwell for her leadership on this issue and we sincerely appreciate her colleagues’ support.”

PBMs commonly bill plan sponsors much more than they reimburse pharmacies for dispensing a prescription and pocket the difference. In addition, rebates from brand name drug manufacturers are passed on to plan sponsors only after the PBM retains a large share. The pursuit of more rebates to pad PBM profits has been known to lead them to switch patients from generic drugs to equally effective, pricier brand name medicines. Traditionally, plan sponsors have been aware of little to none of these and other questionable PBM practices.

The Cantwell amendment would require PBMs to provide basic aggregate information so that health plan sponsors can make educated decisions about which PBM, if any, offers the best value for the plan and patients. Under the amendment, plan sponsors and the commissioners of any state insurance exchange could have access to data in three key areas:
First, a breakdown of those prescriptions provided through retail pharmacies as well as mail-order pharmacies and the generic drug dispensing and substitution rates of each.
Second, the average aggregate amount and characterization of rebates and other discounts paid by manufacturers, and the aggregate amount kept by PBMs.
Third, the average aggregate difference between the amount the PBM is paid by the plan and the average aggregate amount the retail and mail-order pharmacies are paid, respectively, for dispensing a prescription.
The disclosure requirements only apply to PBMs operating in a health insurance exchange. In July, the House Energy and Commerce Committee approved a similar amendment, authored by Rep. Anthony Weiner (D-NY), to its health reform plan (H.R. 3200). The Congressional Budget Office indicated to House staff that the disclosure provision would not increase federal spending.

NCPA and consumer groups have consistently advocated PBM reform. NCPA testified before a Senate Commerce Subcommittee in July and submitted comments to a House Oversight and Government Reform Subcommittee hearing in June on the Federal Employee Health Benefits Program. At the latter, a top government auditor testified that there’s a “good chance” taxpayers and plan participants are “not getting a good deal because of the lack of transparency” by PBMs.

The National Community Pharmacists Association, founded in 1898, represents the nation’s community pharmacists, including the owners of more than 23,000 pharmacies. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation’s retail prescription medicines. To learn more go to the NCPA Web site.

• Patients Don’t Like Mail Order: NCPA Survey

A patient survey conducted by NCPA that found widespread problems with mail order pharmacies provoked a swift response from the PBM industry, which attacked NCPA as “a lobbying organization committed to higher pharmacy costs.”

The survey found 48% of respondents who were mail order customers had to go without their medications because of late delivery. Those patients who were required by their health plan to use mail order reported much higher rates of late delivery (63%) than those who had a choice of pharmacy (28%).

Patients also reported routinely paying for prescription drugs twice: once for the mail order and a second time at community pharmacies for an emergency fill when the first purchase did not arrive in time. Nearly every patient (85%) left waiting for their medicine by mail reported having this experience. Some 81% of respondents told NCPA they strongly or somewhat oppose a mandatory mail order requirement being imposed on health plan participants.

The PBM/mail order lobby, the Pharmaceutical Care Management Association, called on Congress to lift the ban against mandatory mail order in Medicare Part D. Without apparent irony, PCMA noted that when seniors are free to choose mail order they do so 75% less than retirees in employer-sponsored plans where mail order often is mandatory.

• Potential Tamiflu Errors

The FDA has issued a Public Health Alert to notify pharmacists and prescribers about potential dosing errors with Tamiflu (oseltamivir) for Oral Suspension. U.S. health care providers usually write prescriptions for liquid medicines in milliliters (mL) or teaspoons, while Tamiflu is dosed in milligrams (mg). The dosing dispenser packaged with Tamiflu has markings only in 30, 45, and 60 mg.

• Prevacid 15MG Switch to OTC This November

In November 2009, Prevacid 15MG will be switching to OTC. There will be three sizes: 14ct, 28ct, and 42 ct

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