Archive for September, 2005

PCMA Kicks Off New Advertising Campaign Highlighting Cost-Savings Potential Of Medicare Mail-Service Pharmacies

Wednesday, September 28th, 2005

‘Ready, Set, Save!’ Campaign Highlights Federal Trade Commission Report Finding PBM Mail-Service Pharmacies More Cost-Effective than Chain Drugstores

(Washington, DC)—At a time when policymakers are debating how best to fund existing obligations â?? including the Medicare prescription drug benefit â?? and to address new priorities, the Pharmaceutical Care Management Association (PCMA) today kicked off a new advertising initiative to remind policymakers that Medicare mail-service pharmacies have the potential to save Medicare and seniors tens of billions of dollars over the next decade, the association said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

“Mail-service pharmacies are already projected to save the Medicare program and seniors $44 billion over the next decade. If used to their full potential, Medicare mail-service pharmacies could save seniors and the government an additional $42 billion in the same period,” said PCMA President Mark Merritt in announcing the new campaign. “It’s important that policymakers and the private sector do everything possible to encourage the use of Medicare mail-service pharmacies for those seniors who can benefit from it.”

While patients with short-term acute-care needs typically receive their prescriptions in the retail setting, those patients with chronic conditions such as high-blood pressure and high cholesterol could be better served by mail-service pharmacies. The mail-service pharmacy option offers increased savings and, since medications can be automatically delivered to the home as each fill ends, helps consumers better comply with their prescription regimen. Furthermore, mail-service pharmacies have pharmacists available over the phone 24/7 to assure consumers the ability to ask and get the answers for any questions they may have about their medication(s). Taken together, mail-service pharmacy satisfaction scores very high in terms of the condition of the drugs received, correct drugs delivered, and ease of refilling prescriptions, according to a 2004 survey of consumers in mail-service pharmacy. In 2006, Lewin estimates that about 24 percent of Medicare beneficiaries’ prescription drug expenditures will flow through mail-service pharmacies.

Overview of FTC Report

Section 110 of the Medicare Modernization Act (MMA) required the FTC to conduct the study to determine whether group health plans using “integrated” PBMs incur higher costs than plans using “non-integrated” mail-service pharmacies and/or retail pharmacies. During the Medicare prescription drug debate in Congress in 2003, retail pharmacies â?? relying on a retail industry-funded study by a group called LECG — sought to prohibit Medicare prescription-drug plan sponsors from being able to offer plans with a “captive” mail-service pharmacy benefit. As a compromise, the Medicare conferees agreed to an FTC study to examine this issue in further detail. The FTC voted unanimously, 4-0, to accept the findings in the report.

The FTC released its mail-service pharmacy study earlier this month. In conducting its report, the FTC examined 26 PBM contracts with plan sponsors as well as data from retail pharmacies. Among the key findings from the report:

Prescription drugs purchased at PBM mail facilities cost less than the same drugs purchased at non-PBM/retail owned facilities. For large PBMs, average total prices in 2002 and 2003 at PBM-owned mail-order pharmacies typically were lower than retail-owned mail-service pharmacies and chain drugstores. For a common basket of drugs dispensed in one month with the same-size prescriptions, mail prices were lower than retail prices at both large PBMs and retailer-owned PBMs

Generic substitution rates at PBM-owned facilities were generally equal to non-PBM/retail owned pharmacies. The FTC’s findings confirm an earlier analysis of 670 million pharmacy claims by Harvard Business School researchers that generic substitution at PBM-mail-service pharmacies and mail-service pharmacies owned by retail chains are essentially the same. The Harvard Business School findings were peer-reviewed and were featured on Health Affairs website in July 2004.

PBMs rarely switch drugs through therapeutic interchange programs and, when it occurs, reduces sponsors’ costs in a majority of cases.

The FTC flatly calls “without merit” the retail pharmacy industry’s charge that PBMs are engaging in “self-dealing” when they both administer the pharmacy benefits for a client as well as sell drugs to the client’s members via the PBM’s own mail-order pharmacy.

Contact Information:
Phil Blando
202-207-3614

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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.

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PCMA: Families USA Proposal for Medicare Drug Benefit Would Mean Fewer Choices, Less Access for America’s Seniors

Tuesday, September 27th, 2005

(Washington, DC)—Seeking to downplay the fact that just last week the Medicare program announced that seniors and disabled beneficiaries will enjoy lower-than-expected premiums and an array of private drug-plan choices in the upcoming Medicare prescription drug benefit, Families USA today instead repeated its call for a Veterans’ Administration (VA) model of drug delivery that, in the end, would severely restrict seniors’ access to drugs and result in a massive cost-shift to the private sector, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

“The VA model is a non-starter for the Medicare program and for anyone who cares about balancing prescription drug cost and access,” said PCMA President Mark Merritt. “Under the VA approach, America’s seniors and disabled beneficiaries would have severely restricted choices and the commercial marketplace would be subject to a massive cost shift as artificially low drug prices in Medicare forced working families, unions, and small businesses to pay more for their prescriptions. When utilized to their full potential, PBMs can help consumers and purchasers reduce prescription drug costs by an average of 25 percent and provide broad access to brand-name and generic drugs at thousands of retail and mail-service pharmacies nationwide.”

PCMA believes the report fails the credibility test in a wide range of areas:

The VA model would severely restrict seniors’ access to drugs, especially when compared to the Medicare drug discount card. The “solution” touted in the report â?? Medicare direct negotiation modeled after the Veterans’ Administration program â?? would lead to fewer drug choices for seniors. The VA national formulary requires access to prescription drugs in 34 classes. By contrast, commercial formularies typically cover drugs in 50 to 100 classes. The new permanent Medicare drug benefit requires coverage for about 146 categories of drugs. The current Medicare drug discount card requires discounts for 209 categories of drugs. ”

The report is misleading because it attempts to compare an insured pharmacy benefit with simple drug discounts available to consumers at the point-of-sale. Families USA is confusing the drug prices obtained under a permanent, insured pharmacy benefit â?? the VA — with the drug prices obtained under an interim 18-month voluntary program offering consumers discounts at the point-of-sale at their retail pharmacy. These differences make any valid comparison between the VA and the Medicare discount card program nearly impossible.

The VA model would lead to massive cost-shifting in other parts of the health care system, including the private marketplace. VA drug spending represents about one percent of all prescription drug spending. Medicare beneficiaries, by contrast, are estimated to account for about 40 percent of prescription drug spending. Because the VA drug spending represents only one percent of drug spending, cost shifting is kept to a minimum. Moreover, the VA pays fixed prices for drugs that are established by law. For example, brand-name drugs listed on the Federal Supply Schedule (FSS) are automatically provided to the VA at a 24 percent lower price than average private-sector price. Pulling 40 percent of all drug spending under the VA-style umbrella â?? and requiring an automatic 24 percent discount for brand-name drugs under the FSS â?? would represent a massive disruption in the marketplace and lead to billions of dollars of higher drug costs in other parts of the system.

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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

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PCMA: Pharmacy Benefit Managers Proud to Play Central Role in Administering Medicare Prescription Drug Benefit

Friday, September 23rd, 2005

(Washington, DC)— PCMA President Mark Merritt issued the following statement regarding the Centers for Medicare and Medicaid Services’ (CMS) announcement today about the prescription drug plan choices available to Medicare beneficiaries in 2006:

“Today’s announcement by CMS is a turning point for America’s seniors and disabled beneficiaries. For the first time ever, all seniors will have access to a wide range of health plan choices providing integrated prescription drug coverage.

“America’s pharmacy benefit managers (PBMs) are proud to play a central role in administering this new benefit. In the commercial marketplace, PBMs have a proven record of negotiating deep discounts for purchasers and helping to expand consumers’ access to a wide range of clinically proven, cost-effective prescription drugs.

“In the coming year and beyond, PCMA looks forward to working closely with beneficiaries, CMS, and others to ensure that Medicare builds on PBMs’ record in the commercial marketplace.”

PCMA is the national association representing America’s pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for 200 million Americans with drug coverage provided through health insurance plans, employers, labor unions, and other purchasers.

# # #

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

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PCMA: Pharmacy Benefit Management (PBM) Tools Key to Stretching Medicare Drug-Benefit Dollars

Sunday, September 18th, 2005

If Used Potential, Mail-Service Pharmacies Alone Could Save Medicare $86 Billion on Prescription Drug Costs Over Next Decade

(Washington, DC)—As discussions continue about how best to fund promises already made to America’s seniors and disabled â?? including the new Medicare prescription drug benefit â?? and to fulfill new obligations, the Pharmaceutical Care Management Association (PCMA) today reminded policymakers that fully utilizing pharmacy benefit management tools from the commercial marketplace is likely to save billions of dollars on the cost of the Medicare prescription drug benefit over the next decade, the association said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs) and specialty pharmacy providers (SPPs).

“As policymakers continue to look for ways to keep promises already made to seniors and to fund new challenges, it is important that they recognize that fully utilizing pharmacy benefit management tools from the commercial marketplace can help Medicare save billions of dollars over the next decade on prescription drug costs,” said PCMA President Mark Merritt. “Fully leveraging just one PBM tool from the commercial marketplace â?? the mail-service pharmacy option â?? alone would save Medicare $86 billion on prescription drug costs over the next decade.”

According to an August 2005 report commissioned by PCMA and conducted by the Lewin Group, mail-service pharmacies provide savings of 10 percent compared to retail pharmacies based on a review of the published evidence. At its current level of market penetration, mail-service pharmacy will save the health care system $78.9 billion in drug expenditures from 2006-2015. This includes $44.3 billion for Medicare and $34.6 billion for the commercial sector. According to Lewin, Medicare could see savings of as much as $86 billion over the next decade if it fully embraced the mail-service pharmacy option for beneficiaries. The complete Lewin study, “Mail-Service Pharmacy Savings: A Ten-Year Outlook for Public and Private Healthcare Purchasers,” is available on PCMA’s website at www.pcmanet.org.

# # #

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

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PCMA: New Health IT Studies Underscore Need For Uniform, National Electronic Prescribing Standards

Wednesday, September 14th, 2005

RAND Researchers Find Widespread Adoption of Health IT Could Save Billions, Prevent 2 Million Adverse Drug Events; Call for National Standard

Merritt Calls on Medicare to Address Major Barrier â?? Lack of Uniform E-Prescribing Standards â?? To Realizing Full Cost-Savings and Quality Potential of Health IT

(Washington, DC)—New studies released today finding that widespread adoption of health information technology (IT) â?? including electronic prescribing (e-prescribing) â?? has the potential to save billions of dollars annually on health care costs and prevent more than 2 million adverse drug events underscore the need for uniform, national e-prescribing standards that will accelerate adoption of these systems throughout the entire health care system, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

“The dramatic findings contained in these studies suggest that e-prescribing and health IT could be as critical to good health as eating right, exercising, and an annual physical,” said PCMA President Mark Merritt. “PBMs have been at the forefront of implementing e-prescribing and other health information technology that helps improve outcomes, enhance safety, and reduce costs. CMS has the opportunity, as part of its implementation of the new Medicare drug benefit, to set a national e-prescribing standard that would accelerate health IT adoption and realize its full cost-savings and quality-improvement potential.”

The studies were conducted by researchers at the RAND Corporation and Centers for Medicare & Medicaid Services (CMS) and are featured in the September/October 2005 edition of Health Affairs. Among the key findings from the studies:

To accelerate adoption of health-information technology, researchers recommend that electronic medical records conform to a national set of standards.

Widespread adoption of electronic medical records could save Medicare $23 billion per year and private payers could see annual savings of $31 billion.

Widespread adoption of health-information technology â?? including electronic medical records and similar e-prescribing technology â?? has the potential to help prevent more than 2 million annual adverse drug events in hospitals and doctors’ offices. Each avoided event can save $1000-$2000 through avoided office visits, hospitalizations, and other avoided care. Seniors, in particular, would benefit from this technology as they account for a significant portion of adverse drug events.

The Medicare Modernization Act calls for participating plans to support e-prescribing programs in conjunction with voluntary participation by pharmacies and physicians. PCMA believes strongly that for Medicare to realize the full cost-savings and quality-improvement potential associated with e-prescribing, Medicare should move quickly to adopt a uniform national standard that relies upon the most advanced technology working in the commercial marketplace today. A 50-state patchwork approach would increase costs and worsen regional variations in health care quality and outcomes.

Read the study

# # #

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

Contact Information:
Phil Blando
202-207-3614

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Hurricane Katrina and Hurricane Rita Web-Links for State Emergency Rules/Orders and Medicaid Information

Wednesday, September 7th, 2005

Hurricane Katrina State & Federal Regulatory Alerts Chart

Alabama
Board of Pharmacy—Emergency re-fills
http://www.albop.com/
Medicaid Agency
http://www.medicaid.state.al.us/news/hurricane_update.aspx?tab=2
Medical Association of AL
http://www.masalink.org/
DOI–Health Insurance Coverage
http://www.aldoi.gov/PDF/Legal/2005-09-09-KatrinaHealthBulletin.pdf
DOI–Health Insurance Grace Periods
http://www.aldoi.gov/PDF/Legal/2005-09-08-KatrinaGraceBulletin.pdf
Arkansas
Executive Order—Emergency re-fills
http://www.arkansas.gov/governor/executive_orders/pdf/EO-05-13.pdf
Medicaid
http://www.medicaid.state.ar.us/Download/Katrina/info.pdf

Florida
Emergency re-fills (1)
http://www.dot.state.fl.us/mcco/archive/HurricaneKatrina/FL%20ExecOrder%20-%20Katrina.pdf
Emergency re-fills (2)
http://www.doh.state.fl.us/mqa/pharmacy/frm_Katrina.pdf
Emergency re-fills FAQs
http://www.doh.state.fl.us/mqa/pharmacy/faq_hurricane.pdf
Medicaid
http://www.fdhc.state.fl.us/Medicaid/pdffiles/katrina.pdf
Florida–Hurricane Rita
Medicaid
http://ahca.myflorida.com/Executive/Communications/Press_Releases/09_19_2005.shtml
Executive Order
http://www.fldfs.com/companies/pdf/Executive_Order_05-183.pdf
OIR—Order for Early Prescription Re-fills
http://www.fldfs.com/companies/pdf/Rita_Prescription_Order.pdf

Georgia
Executive Order
http://www.gov.state.ga.us/ExOrders/08_31_05_02.pdf
Medicaid–Hurricane Rita
http://dch.georgia.gov/00/article/0,2086,31446711_31450193_42336748,00.html

Indiana
Executive Order–Hurricane Rita
http://www.in.gov/gov/media/eo/EO_05-28.pdf

Kentucky
Medicaid–Hurricane Katrina
http://chfs.ky.gov/dms/h
Medicaid–Hurricane Rita
http://kentucky.fhsc.com/

Louisiana
Executive Order—Suspending out-of-state licensure for medical professionals
http://www.state.la.us/osr/other/kbb05-26.htm
Extension of Executive Order for Katrina/Rita–Licensing
http://www.gov.state.la.us/2005 Executive orders/47execAmend-KBB2005-33-SuspMedProfLicensure.pdf
Extension of Executive Order for Katrina/Rita–Prescription deadlines
http://www.gov.state.la.us/2005 Executive orders/48execAmend-KBB2005-32-Prescription-Peremption.pdf
Emergency Prescription Drugs
http://www.dhh.state.la.us/offices/news.asp?ID=145&Detail=593
Medicaid
http://www.lamedicaid.com/provweb1/default.htm
http://www.dhh.louisiana.gov/offices/page.asp?id=92&detail=5152
http://www.dhh.louisiana.gov/offices/?ID=180
Dept. of Insurance, Emergency Rule 15–Cancellations
http://www.ldi.state.la.us/whats_new/Emer_Rule_15FinalRule.pdf
Dept. of Insurance, Emergency Rule 17—Health Insurance
http://www.ldi.state.la.us/whats_new/Emer_Rule_17FinalRule.pdf
Hurricane Katrina General Information
http://katrina.louisiana.gov/
Bd. of Pharmacy: Hurricane Katrina/Rita Guidelines
http://www.labp.com/
HHS–Hurricane Rita Waiver for LA and TX
http://www.hhs.gov/emergency/ritawaiver.html

Michigan
Medicaid
http://www.michigan.gov/mdch/0,1607,7-132–125544–,00.html#medicaid

Mississippi
Medicaid
http://msmedicaid.acs-inc.com/general/GetBreakingNews.do
DOI–Health Insurance—Moratorium/Extension of Grace Periods
http://www.doi.state.ms.us/bulletins/20057bull.pdf

Missouri
Executive Order—health care provider licensure
http://www.gov.mo.gov/eo/2005/eo05_026.htm
Medicaid
http://dss.missouri.gov/dms/dated/katrina.htm
Executive Order–Hurricane Rita
http://www.gov.mo.gov/eo/2005/eo05_036.htm

North Carolina
Medicaid
http://www.dhhs.state.nc.us/dma/Katrina%20Medicaid.pdf

Ohio
Medicaid
http://jfs.ohio.gov/ohp/provider.stm

Oklahoma
Medicaid
http://www.okhca.org/about/katrina.asp

South Carolina
Executive Order—licensure waiver
http://www.scgovernor.com/uploads/upload/2005-20_PuttingSCEmergencyOperationsPlaninPlace.pdf

Tennessee
Health Professional—Temporary licensure
http://www2.state.tn.us./health/katrina_relief.htm
Licensing and Prescriptions
http://www.tennessee.gov/governor/AdminCMSServlet?action=viewFile&id=606

Texas
Board of Pharmacy—Emergency re-fills
http://www.tsbp.state.tx.us/hurricaneinfo.htm
Medicaid and TANF
http://www.governor.state.tx.us/priorities/health_safety/hurricane/assistance_info
HHS Grants Medical Care Payments for Evacuees in TX
http://www.os.dhhs.gov/news/press/2005pres/20050915b.html
Dept. of Aging and Disability Services
http://www.dads.state.tx.us/

Texas–Hurricane Rita
Governor Proclamation
http://www.governor.state.tx.us/divisions/press/proclamations/proclamation.2005-09-20
Bulletin regarding Rita
https://wwwapps.tdi.state.tx.us/inter/asproot/commish/news/clips2005.asp?id=43
DOI—Medical Equipment and Services
http://www.tdi.state.tx.us/bulletins/b-0055-05.html
DOI—Waiver of Contractual Restrictions
http://www.tdi.state.tx.us/bulletins/b-0054-05.html
DOI—Out-of-Network Services
http://www.tdi.state.tx.us/bulletins/b-0048-05.html
DOI—90-day Prescription Re-fill
http://www.tdi.state.tx.us/bulletins/b-0047-05.html
Medicaid
http://www.tmhp.com/txtlstvw.aspx?LstID=43625023-3329-42fa-9f5e-0421c6a3f83b
HHS–Hurricane Rita Waiver for TX and LA
http://www.hhs.gov/emergency/ritawaiver.html
Dept. of Aging and Disability Services
http://www.dads.state.tx.us/

Virginia
Executive Order
http://www.governor.virginia.gov/Press_Policy/Executive_Orders/html/EO_97.html
Expansion of Executive Order to cover Hurricane Rita
http://www.governor.virginia.gov/Press_Policy/Executive_Orders/html/EO_97.html
Emergency re-fill order
http://www.nabp.net/ftpfiles/NABP01/KatrinaPharmacyOrder.pdf

Wisconsin
Emergency Dispensing Policy
http://drl.wi.gov/prof/phar/whatsnew.htm
Medicaid
http://www.dhfs.state.wi.us/medicaid/updates/2005/2005-61.htm

Federal
Centers for Medicare and Medicaid Services
http://www.cms.hhs.gov/katrina/
CMS: Medicaid Q & A s
http://www.cms.hhs.gov/katrina/medicaid.pdf

U.S. Department of Health & Human Services
http://www.os.dhhs.gov/katrina/index.html
HHS: HIPAA Privacy and Disclosure in Emergency Situations
http://www.hhs.gov/ocr/hipaa/KATRINAnHIPAA.pdf
HHS Grants Medical Care Payments for Evacuees in TX
http://www.os.dhhs.gov/news/press/2005pres/20050915b.html
HHS–Hurricane Rita Waiver for LA and TX
http://www.hhs.gov/emergency/ritawaiver.html

Department of Homeland Security—Waivers and Dispensations
http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0718.xml

Links to State Insurance Departments
http://www.naic.org
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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.

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PCMA: Federal Trade Commission Finds PBM Mail-Service Pharmacies Provide More Savings than Retail Pharmacies

Tuesday, September 6th, 2005

FTC Dismisses Anti-PBM Allegations as “Without Merit

(Washington, DC)—In an unanimous ruling today, the Federal Trade Commission (FTC) has found that PBM mail-service pharmacies offer large employers, unions, and health insurers lower prescription drug prices than the retail pharmacy industry’s chain drugstores and mail-service pharmacies and, in doing so, has validated â?? once and for all â?? the value that pharmacy benefit management can provide to consumers, purchasers, and the health system overall, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs).

“The Federal Trade Commission’s unanimous finding today that PBM-owned mail-service pharmacies provide lower drug prices than drugstores and mail-service pharmacies owned by retail chains confirms what other government and industry data â?? including the Congressional Budget Office, the Government Accountability Office, PricewaterhouseCoopers, the Harvard Business School, and the Lewin Group â?? have successively shown since 2002,” said PCMA President Mark Merritt. “Once and for all, this report gives a green light to policymakers and purchasers to embrace the PBM mail-service pharmacy option for seniors, the disabled, and working families.”

In conducting its report, the FTC examined 26 PBM contracts with plan sponsors as well as data from retail pharmacies. Among the key findings from the FTC report:

�¼ For large PBMs, average total prices in 2002 and 2003 at PBM-owned mail-order pharmacies typically were lower than retail-owned mail-service pharmacies and chain drugstores.

Ã?¼ The FTC flatly calls “without merit” the retail pharmacy industry’s charge that PBMs are engaging in “self-dealing” when they both administer the pharmacy benefits for a client as well as sell drugs to the client’s members via the PBM’s own mail-order pharmacy.

Ã?¼ Throughout the report, the FTC repeatedly notes that PBMs’ interests
are aligned with those of its employer and health-plan customers.

�¼ For a common basket of drugs dispensed in one month with the same-size prescriptions, mail prices were lower than retail prices at both large PBMs and retailer-owned PBMs.

Ã?¼ Pharmaceutical manufacturers’ payments to PBMs are appropriate and responsive to the competitive marketplace: “manufacturers readily raised and lowered allowance levels for each of their drug products as competition developed in the drug’s therapeutic class,” with higher allowance levels for drugs on restrictive formularies.

Section 110 of the Medicare Modernization Act (MMA) required the FTC to conduct the study to determine whether group health plans using “integrated” PBMs incur higher costs than plans using “non-integrated” mail-service pharmacies and/or retail pharmacies. During the Medicare prescription drug debate in Congress in 2003, retail pharmacies â?? relying on a retail industry-funded study by a group called LECG — sought to prohibit Medicare prescription-drug plan sponsors from being able to offer plans with a “captive” mail-service pharmacy benefit. As a compromise, the Medicare conferees agreed to an FTC study to examine this issue in further detail. The FTC voted unanimously, 4-0, to accept the findings in the report.

This new FTC report comes on the heels of new research commissioned by PCMA and conducted by the Lewin Group finding that mail-service pharmacies provide savings of 10 percent compared to retail pharmacies based on a review of the published evidence. According to Lewin, at its current level of market penetration, mail-service will save the health care system $78.9 billion in drug expenditures from 2006-2015. This includes $44.3 billion for Medicare and $34.6 billion for the commercial sector. If all prescriptions that could appropriately be filled through mail-service were filled through mail-service, Lewin estimates that drug expenditures would be reduced by an additional $99 billion from 2006-2015. This includes $42.2 billion for Medicare and $56.8 billion for the commercial sector. The cumulative savings that mail-service pharmacies could provide the health system during the next ten years amounts to $177.9 billion, based on existing and potential mail-service market penetration. The complete Lewin study, “Mail-Service Pharmacy Savings: A Ten-Year Outlook for Public and Private Healthcare Purchasers,” is available on PCMA’s website at www.pcmanet.org.

# # #

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

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