PCMA: Choose PBMs’ Cost Saving Tools Instead of Raising Taxes or Cutting Benefits

Washington, DC; 11.22.04 — Mark Merritt, President of the Pharmaceutical Care Management Association (PCMA) issued the following statement in response to yesterday’s New York Times’ article detailing states’ prescription drug cost pressures and infighting with the drug manufacturers’ lobby over cost-control efforts. PCMA is the national association representing America’s pharmacy benefit managers:

” At a time when health care costs are overwhelming state and federal budgets, we need to work together to find reasoned private-sector solutions to controlling prescription drug costs. We won’t get there by diminishing private-sector competition, only by opening the doors to more competition and to proven tools that have managed drug costs, while also promoting quality and safety.

“America’s pharmacy benefit managers (PBMs) are a big part of the solution — driving down prescription drug costs by an average of 25 percent in the private sector and, according to a recent study PricewaterhouseCoopers, saving the system an estimated $1.3 trillion dollars on drug spending over the next decade.

“In both Medicare and Medicaid, Congress and the nation’s governors need real, workable solutions, not short-sighted private agendas that don’t move the cost containment ball up-field. Raising taxes and cutting services shouldn’t be the only option for the states and the federal government when it comes to reining in drug spending in these vitally important programs. And it won’t be if we have the good sense to let proven, private-sector solutions pioneered by PBMs be the roadmap for reform.”

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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmaceutical benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
202-207-3614

Phoenix, Arizona; 11.18.04 — Consumers relying upon the mail-service pharmacy option are overwhelmingly satisfied â?? with Medicare beneficiaries reporting the highest levels of satisfaction â?? and would recommend this option to family and friends, according to a new mail-service pharmacy satisfaction report, the Pharmaceutical Care Management Association announced today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

” Numerous data have shown that mail-service pharmacy is a proven avenue to providing consumers and purchasers with lower prescription drug costs, improved safety, more privacy, and greater drug therapy compliance,” said PCMA President Mark Merritt. “With these findings, we now know that mail-service pharmacy consumers are also overwhelmingly satisfied on a wide range of indicators â?? timeliness of drug delivery, condition and accuracy of drugs received, and ease of reaching a pharmacist. With seniors reporting the highest levels of satisfaction in the survey, these data are an important reminder to policymakers to preserve the mail-service pharmacy option for Medicare beneficiaries in the new Medicare drug benefit.”

The findings are based on a Fall 2004 survey of 11,697 consumers with drug benefits provided through 20 mail-service pharmacies administered by PBMs and retail pharmacies. Among the key findings:

Mail-service pharmacy consumers are highly satisfied. According to the survey, 92 percent of consumers are “very satisfied” or “somewhat satisfied” with the mail-service pharmacy option. An additional four percent are “neutral.” Only four percent of consumers report being “dissatisfied.”
Mail-service pharmacy consumers would overwhelmingly recommend this option to family and friends. Fully 95 percent of consumers would recommend their mail-service pharmacy to family and friends.
The more consumers use mail-service pharmacy, the more satisfied they become. Consumers with four or more years’ experience in using the mail-service pharmacy option report the highest levels of satisfaction â?? fully 94 percent are “very satisfied” or “somewhat satisfied.” Consumers with one year or less experience in using the mail-service pharmacy option report slightly lower satisfaction rates of 90 percent.
Medicare beneficiaries are intensely satisfied with the mail-service pharmacy option. Fully 95 percent of Medicare beneficiaries report being “very satisfied” or “somewhat satisfied” with the mail-service pharmacy option. Medicare beneficiaries report being intensely satisfied â?? 80 percent of Medicare beneficiaries in the survey report being “very satisfied” with the mail-service pharmacy option. While the report does not identify explicitly why Medicare beneficiaries are intensely satisfied, other data suggest that seniors may prefer the mail-service option because of ease of refilling prescriptions, particularly for seniors with limited mobility.
Mail-service pharmacy consumers report high satisfaction levels on a wide range of indicators:

Condition of Drugs Received â?? 98 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Correct Drugs Delivered â?? 98 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Helpfulness of Educational Inserts — 98 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Ease of Refilling Prescriptions — 97 percent are “very satisfied,” “somewhat satisfied,” or “neutral.
Professionalism of Service Representatives - 97 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Timeliness of Drug Delivery - 94 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Requesting New Prescriptions - 94 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”
Ability to Get Answers to Questions - 94 percent are “very satisfied,” “somewhat satisfied,” or “neutral.
Ease of Reaching a Pharmacist - 93 percent are “very satisfied,” “somewhat satisfied,” or “neutral.”

The sponsors of the report, Fujisawa, Schwarz Pharma, Wyeth, Berlex had this to say about the results, “We understand the important role played by mail service pharmacy and specialty pharmacy in the delivery of pharmaceutical products. The research confirms the convenience and value these modes of delivery provide to patients and the unique niche mail service pharmacy and specialty pharmacy provide in the overall delivery of health care in the United States.”

The survey was sponsored by a grant from Fujisawa Healthcare, Inc; Schwarz Pharma LLC, Wyeth Pharmaceuticals, and Berlex Laboratories.

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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmaceutical benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
202-207-3614

Could Mean Higher Medicare Premiums for Seniors, Billions in Unnecessary Costs

Washington, DC; 11.17.04 — The Pharmaceutical Care Management Association (PCMA) today kicked off a new print advertising initiative to highlight for policymakers how the drug manufacturers’ agenda regarding the Medicare drug benefit could mean billions of dollars in unnecessary costs and higher Medicare premiums for seniors, the association said today. The ad highlights the drug industry’s strategy to circumvent PBMs’ cost-saving tools in the new drug benefit and asks “Guess Who’s Coming to Dinner” against the backdrop of a photo of a Sumo wrestler. The answer? “The big drug companies who are hungry for more profits.”

PCMA is the national association representing America’s pharmacy benefit managers (PBMs). In the private marketplace, PBMs work on behalf of employers, labor unions, health insurers, and government health programs to negotiate with the drug manufacturers and retail pharmacies for lower drug prices. According to a recent analysis by PricewaterhouseCoopers, PBMs drive down the cost of prescription drugs by an average of 25 percent and will save seniors in both Medicare and employer-sponsored retiree programs nearly $700 billion in prescription drug costs over the next decade. And, by the drug makers’ lobby’s own admission, PBM formularies already provide coverage for all of the top 50 drugs most commonly prescribed to seniors.

“The drug makers’ agenda is to force Medicare to effectively guarantee sales of their most lucrative drugs â?? and all without making them compete against one another to generate savings for the program. This could mean billions of dollars in unnecessary costs and higher premiums for seniors,” said PCMA President Mark Merritt. “This agenda would gut the competitive marketplace the drug makers claim to want and would lead to more expensive drugs for seniors.”

PCMA has launched the new advertising initiative to inform policymakers about the downsides of allowing the drug makers too much sway over the design of the Medicare prescription drug benefit. With the Administration and the US Pharmacopeia working over the next six weeks to finalize model Medicare formulary guidelines, critical decisions are pending that could have a significant impact on the program’s costs, beneficiary premiums and co-payments, and the effectiveness of PBM participation in the new benefit.

Seniors Wary of Pharma Lobby’s Agenda

Last week, PCMA released a new post-election survey of seniors finding they have serious concerns about the role of the drug companies in determining which drugs Medicare should and should not cover. Nearly 70 percent think involving the drug manufacturers in the design of the new drug benefit is a bad idea and only 15 percent think it is a good idea. Eighty-two percent of seniors think that “Medicare should make the drug manufacturers compete with one another to provide discounts on their drugs, which could produce lower Medicare premiums and co-pays,” while only 8 percent think “Medicare should accept the recommendations of the drug manufacturers to pay for as many of their drugs as possible, even though that could lead to higher Medicare premiums and co-pays.” No differences emerge on this question between Bush and Kerry voters. The post-election survey of 800 seniors was conducted by Ayres McHenry & Associates November 3-7, 2004.

A copy of the new PCMA advertisement is below.

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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmaceutical benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
202-207-3614

Implications Foreseen for Medicare Model Formulary Guidelines

Washington, DC; 11.10.04 — Seniors voting in last Tuesday’s presidential election favor a Medicare prescription drug benefit that promotes a choice of plans and drives down prices through competition, but also have serious concerns about the drug manufacturers’ role in influencing the design of that new benefit, according to new post-election polling data released today by the Pharmaceutical Care Management Association (PCMA). PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

“Seniors voting in last week’s election clearly want a Medicare drug benefit that promotes a choice of drug plans and lowers costs through competition. This approach is the essence of the PBM model that has worked to drive down costs by an average of 25 percent and expand access in other parts of the system,” said PCMA President Mark Merritt. “For policymakers, seniors are raising a red flag about drug manufacturers’ role in designing the drug benefit. Seniors don’t want drug manufacturers determining what drugs Medicare should pay for, especially if it means higher premiums and co-payments. These data show that approach is a political loser.”

Among the key findings:

More than eight out of ten seniors think Medicare should make drug manufacturers compete with one another to provide discounts on their drugs, rather than accept the recommendations of the drug manufacturers about which drugs should be covered. Eighty-two percent of seniors think that “Medicare should make the drug manufacturers compete with one another to provide discounts on their drugs, which could produce lower Medicare premiums and co-pays,” while only 8 percent think “Medicare should accept the recommendations of the drug manufacturers to pay for as many of their drugs as possible, even though that could lead to higher Medicare premiums and co-pays.” No differences emerge on this question between Bush and Kerry voters.
Seven out of ten seniors think it is a bad idea to have drug manufacturers helping to determine which of their drugs Medicare should and should not cover. Sixty-nine percent think involving the drug manufacturers in the coverage decision is a bad idea, and only 15 percent think it is a good idea. Sixty-four percent of Bush voters think it is a bad idea, as do 75 percent of Kerry voters.
Seniors think the drug companies are motivated more by increasing their profits than by providing seniors more choices when they work to have Medicare cover as many of their own drugs as possible under the prescription drug benefit. Fifty-four percent think the drug companies are motivated by profits, and 25 percent think they are motivated by providing seniors choices. Bush voters attribute drug company behavior to profits by a margin of 43 to 33 percent, and Kerry voters agree by a margin of 66 to 16 percent.
More than seven out of ten seniors prefer a drug plan like that enjoyed by members of Congress, rather than a plan similar to one used by the Veterans Administration. Seventy-two percent of seniors say “Medicare should offer seniors a drug plan like members of Congress have, which offers a choice of drug plans with at least 120 categories of drugs,” while 11 percent say “Medicare should offer seniors a drug plan like the one used by the Veterans Administration, which offers one national preferred drug list with 34 categories of drugs.”
The 120 categories is 26 fewer than is currently recommended by U.S. Pharmacopeia in its draft guidelines. PCMA has long advocated that USP should build on proven formularies from the commercial marketplace, which typically rely upon 50 to 100 categories of drugs.

These new data regarding senior voters’ views about the structure of the new Medicare drug benefit have important implications as the Administration and the US Pharmacopeia work over the next six weeks to finalize model Medicare formulary guidelines.

“We are a crossroads,” added Mr. Merritt. “With critical decisions pending about the structure of Medicare model formulary guidelines, seniors have sent a clear signal that they don’t want the drug manufacturers involved in determining which drugs Medicare will pay for â?? especially if it means higher premiums and copayments. These data suggest that approach may well engender a senior backlash.”

The post-election survey of 800 voters 60 years of age and older was conducted by Ayres, McHenry & Associates November 3-7, 2004 and has a margin of error of plus or minus 5.24 percent.

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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmaceutical benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
202-207-3614