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ALEXANDRIA, Va. – Federal Trade Commissioner Alvaro Bedoya and attorneys from the Pennsylvania attorney general’s office participated in a roundtable discussion on Thursday focusing on pharmacy benefit managers’ contracting practices.
The discussion, which took place at Eric’s RX Shoppe in Horsham, Pa., included several independent pharmacy owners from Pennsylvania and staff with the Philadelphia Association of Retail Druggists. Representatives of the National Community Pharmacists Association and the Pennsylvania Pharmacists Association, both of which helped arrange the event, also attended.
PPA CEO Victoria E. Elliott said, “The PPA welcomed this opportunity to have Commissioner Bedoya and attorneys from the attorney general’s office hear firsthand from owner members how difficult it is for independent pharmacies – which are often the only source of health care for many communities in Pennsylvania – to compete in a marketplace where the PBM-owned pharmacies are also allowed to participate.”
The independent pharmacy owners detailed various PBM-related barriers they face in operating their business and serving their patients, and described access issues patients are forced to deal with when their local pharmacies close. Among other things, they discussed take-it-or-leave-it contracts; complicated and opaque methods of determining pharmacy reimbursement; methods of steering patients towards pharmacies owned or affiliated with the PBM-insurer; issues with dispensing generics or biosimilars that are not found on a patient’s formulary; and challenges relating to the “DIR hangover.” This is what NCPA has dubbed the period starting Jan. 1, 2024, when bills for pharmacy direct and indirect remuneration for the end of 2023 will come due to PBMs just as those DIR fees for the beginning of 2024 will be moved to the point of sale. The DIR hangover is a result of provisions taking effect from the Centers for Medicare & Medicaid Services Medicare Part D final rule for contract year 2023.
“Since being sworn in, Commissioner Bedoya has demonstrated his keen interest in understanding the complex issues at play in the pharmacy space and within vertically integrated PBMs,” said NCPA General Counsel Matthew Seiler. “NCPA continues urging the FTC and other regulators to keep digging into PBM-insurer business practices and take action as they’re able to in order to advance transparency, fairness, and competition.”
