ROCHESTER, N.Y. – The National Coalition For Assistive & Rehab Technology (NCART) has submitted an HCPCS coding application to formally appeal CMS’ decision to increase the fee schedule by $13, which was recently released. Wayne Grau, executive director of NCART stated: “While we appreciate CMS’ willingness to listen to our concerns and review the follow-up information we provided, they indicated it could not be considered since it was not part of the public meeting process last year. In addition, we will highlight the problems using internet pricing, which does not reflect the additional significant costs to comply with Medicare requirements compared to that retail model.”
FTC Interim Report On PBMs Warrants Investigation
ALEXANDRIA, VA –The Federal Trade Commission (FTC) recently published an interim report titled, Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. The National Community Pharmacists Association (NCPA) reacted quickly, declaring: “The report left no doubt that these massive health care conglomerates are creating unfair advantages for themselves that are driving up costs for consumers, limiting consumer choices, and killing access to quality pharmacy care.”
The report finds that PBMs wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price. Additionally, it says, the agency “finds that PBMs hold substantial influence over independent pharmacies by imposing unfair, arbitrary, and harmful contractual terms that can impact independent pharmacies’ ability to stay in business and serve their communities.”
In a statement, NCPA CEO B. Douglas Hoey, pharmacist, MBA, praised the FTC’s findings thus far, also reiterating the need for further investigation into PBM-insurers and definitive action to rein them in.
Hoey said via press release: “In recent years, the pharmacy benefits space has undergone massive transformation. It’s no longer 2005. Without question – and as the interim report makes clear – the marketplace has exploded because of countless mergers and acquisitions as well as tactics like patient steering and take-it-or-leave-it contracting. It’s a system that may work for massive PBM middlemen, but it’s anti-consumer and anticompetitive.
“It has been abundantly clear for years that policymakers must level the playing field. Congress must swiftly enact reforms to rein them in, and states should continue doing so,” he continued.
“Regulators at all levels must keep an eye on these entities and enforce the laws on the books. The FTC must continue its investigation and pursue the information that the PBMs have so far defiantly withheld. Patients and community pharmacies need this fight to be finished, and need it urgently.”
The interim report is part of an ongoing inquiry the FTC launched in 2022, during which the agency received more than 24,000 comments from the public – including independent pharmacists – about anticompetitive contracts and how PBM practices affect consumers.