The new drug pricing rule, proposed by the Center for Medicare and Medicaid Services released November 26, is expected to lower patients’ out-of-pocket costs at the pharmacy counter and lead to a more competitive and efficient part D program.
Although the proposal will undergo regulatory language, the rule will ensure greater drug pricing transparency for patients and pharmacists alike. Most significant is the proposal to account for pharmacy price concessions, also known as direct and indirect remuneration fees, at the point-of-sale.
Under the current system, pharmacy benefit managers — the middlemen hired by plan sponsors to administer prescription drug benefits — often claw back fees from pharmacies well after a transaction. Those fees, called direct and indirect remuneration, are often unpredictable and seemingly unconnected to a pharmacy’s performance related to adherence and other standards.
The fees also disadvantage patients, who are assessed a higher cost-share against their Part D deductible rather than the retroactive, lower adjusted price. The result is to push patients more quickly into the so-called Part D donut hole, at which point the patient is responsible for a considerably larger portion of their prescription drug costs.
“We wholeheartedly support moving pharmacy price concessions to point-of-sale to benefit patients in the form of lower cost share,” said Douglas Hoey, MBS, a pharmacist and CEO of the National Community Pharmacy Association (NCPA).
“Such a move will also eliminate retroactive claw-backs charged by PBMs and allow pharmacists a more accurate accounting of drug costs and reimbursements,” added Hoey.
The West Virginia Pharmacists Association joined NCPA in requesting CMS to implement the new rule.