Merritt: Survey Shows Drug Plans Are Paying Promptly, Working Collaboratively with Pharmacies

(Washington, DC)— A Medicare survey has found that 18 of the top 20 Medicare drug plans pay pharmacies on twice-a-month billing cycles of 15 days or less, with most claims being paid within 21-25 days, according to congressional testimony presented yesterday by the Centers for Medicare & Medicaid Services (CMS), the Pharmaceutical Care Management Association (PCMA) said today.

“CMS’ finding that Medicare drugs plans are paying pharmacies promptly — every two weeks or less — underscores our plans’ commitment both to saving seniors money and to working collaboratively with pharmacies,” said PCMA President Mark Merritt. “These findings demonstrate that the Medicare drug benefit is working largely as Congress intended â?? seniors are enjoying a wide range of plan choices with deeper-than-expected discounts and pharmacies are seeing regular payments from plans.”

According to written testimony presented yesterday to the House Energy & Commerce Subcommittee on Health, a CMS survey has found the following:

18 of the top 20 Medicare prescription drug plans (PDPs) pay pharmacy claims on a twice-a-month billing cycle of 15 days or less. These plans account for more than 90 percent of drug coverage for Medicare beneficiaries. A 15-day billing cycle generally provides pharmacies with payment in 21-25 days.

“A clear majority” of PDPs are paying pharmacies well within the 30-day industry standard.
PCMA represents five of the 10 national Medicare PDPs. PCMA member companies have pledged to pay pharmacies submitting clean electronic Part D claims within 30 days. A 30-day standard is consistent with how doctors and hospitals are paid under Medicare Parts A & B, prompt payment laws in 43 states, and the federal employees’ health plan. PCMA member companies process tens of millions of pharmacy claims every month. A 30-day standard helps improve quality, ensure accuracy of payments, and combat fraud and abuse.

PCMA believes strongly that CMS’ findings undermine the drugstore lobby’s chief argument for new legislation that would go far beyond industry claims-payment standards and impose “one-size-fits-all” rules for medication therapy management (MTM) programs. Earlier this week, PCMA released a study from the Moran Company finding that prompt pay and MTM provisions in S. 2563 would increase costs to seniors and the Medicare program by at least $9 billion over ten years. The study was conducted by Steve Lieberman, Partner at the Moran Company, and the former lead health analyst at the Congressional Budget Office (CBO) from 1999-2004. Mr. Lieberman also served as Senior Advisor to the CMS Administrator and helped write the regulations implementing the Medicare Modernization Act.

While S. 2563 would add substantial costs to the Medicare program, PCMA requested an examination of this proposal because it appears to be less onerous than the other, more extreme measures pending in Congress, including two other bills, HR 5182 and HR 5166. PCMA believes strongly that both these bills would increase costs even more than the Senate measure and that the $9 billion in added costs is the minimum cost of the various drugstore lobby proposals. For example, HR 5182 would mandate a dispensing fee of $14 for every generic prescription dispensed under Medicare and HR 5166 would require 10-day payment cycles for Medicare pharmacy claims.

A link to the CMS testimony from yesterday’s hearing can be found at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1864

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605

Moran Company Study Examines PhARM Prompt Pay Proposal Implementing Key Provisions Of Drugstore Lobby’s Medicare Agenda

(Washington, DC) Legislation implementing key provisions of the drugstore lobby’s Medicare prescription-drug agenda would cost seniors and the Medicare program at least $9 billion in added costs over the next ten years, according to a new study conducted by the Moran Company and released today by the Pharmaceutical Care Management Association (PCMA). PCMA is the national association representing Americas pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare.

The study was conducted by Steve Lieberman, a Partner at the Moran Company, a health-care policy research firm based in Arlington, Va. Prior to joining the Moran Company, Mr. Lieberman served as a senior advisor to the Administrator at the Centers for Medicare & Medicaid Services (CMS) and helped in drafting the regulations implementing the Medicare Modernization Act (MMA). In addition, from 1999-2004, Mr. Lieberman served as the lead health analyst for the Congressional Budget Office (CBO), overseeing a staff of 30 focused on health and human resources issues and where he led CBOs team working on the MMA.

PCMA member companies are committed to working with Americas pharmacists to help beneficiaries see lower drug costs and assure pharmacies payment of clean Medicare claims within 30 days, said PCMA President Mark Merritt. Regrettably, at a time when policymakers are doing everything they can to restrain spending and lower the cost of prescription drugs, the drugstore lobby is pushing legislation that would increase drug costs for seniors and the Medicare program by more than $9 billion.

The new study from the Moran Company examines the cost consequences of S. 2563, the Pharmacist Access and Recognition in Medicare (PhARM) Act of 2006, sponsored by Senator Thad Cochran (R-Miss.). The PhARM Act is one of five proposals currently before Congress mandating new Medicare standards for pharmacy claims-payment timeframes, medication therapy management (MTM) programs, and other related provisions.

While the Cochran bill would add substantial costs to the Medicare program, PCMA requested an examination of this proposal because it appears to be less onerous than the other, more extreme measures pending in Congress, including two other bills sponsored by Representatives Marion Berry (D-Ark.) and Roger Wicker (R-Miss.). PCMA believes strongly that the Berry bill and Wicker bill would both increase costs even more than the Cochran bill and that the $9 billion in added costs is the minimum cost of the various drugstore lobby proposals. For example, the Berry bill would mandate a dispensing fee of $14 for every generic prescription dispensed under Medicare and the Wicker bill would require 10-day payment cycles for Medicare pharmacy claims.

Among the key findings from the Moran Companys analysis of the PhARM Act:

The PhARM Act would increase costs to seniors and the Medicare program by $9.4 billion over ten years; and

The PhARM Act would increase seniors Medicare Part D drug premiums by $7.20 in 2008 alone.

In contrast to special-interest legislation that would benefit pharmacies at the expense of seniors and taxpayers, PCMA member companies are committed to working collaboratively with drugstores to ensure they are paid adequately and timely. Earlier this month, PCMA pledged its member companies would pay pharmacists for Medicare Part D pharmacy claims within 30 days of receipt of clean claims, a standard consistent with the way doctors and hospitals are paid under Medicare Parts A & B, 43 state laws, and federal employees health plans.

The more than $7.7 billion score of S. 2563 representing $9.4 billion in higher plan costs and $1.7 billion in higher beneficiary premiums concentrates on the financial implications of the provisions imposing federal prompt payment and MTM requirements, said Steve Lieberman of the Moran Company. These requirements would significantly change contractual provisions under which Part D plans are currently operating.

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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
Charles Coté 202-207-3605

With Study Finding 30 Percent of Medicare Hospital Spending on Chronically Ill Unnecessary, PCMA Urges Policymakers to Resist Efforts to Erode Proven Pharmacy Management Tools

(Washington, DC)—A new report from the Dartmouth Atlas Project finds that as much as 30 percent of Medicare hospital spending on chronically ill seniors may be unnecessary and fails to improve the quality of care provided to beneficiaries. This research underscores the importance and continued need for promoting and enhancing value-based purchasing tools in the new Medicare prescription drug benefit and throughout the entire system, the Pharmaceutical Care Management Association (PCMA) said today.

“Today’s findings from the Dartmouth Atlas Project have important implications for the new Medicare prescription drug benefit,” said PCMA President Mark Merritt. “As we well know from these and other data, there are human and economic costs associated with an unaccountable fee-for-service model. Pharmacy management tools are essential to improving outcomes, reducing variations in care, and ensuring value-based purchasing, particularly for seniors and the disabled. For these reasons, policymakers should resist ongoing efforts to erode these tools in the Medicare drug benefit and turn back the clock to a system with no regard for the real dangers associated with misuse, overuse, and underuse of prescription drugs.”

PCMA believes strongly that a broad-based consensus is emerging about the need to evaluate competing drug therapies and better utilize scarce health care resources. PBMs have been at the forefront of these efforts, especially through pharmacy & therapeutics (P&T) committees and a wide range of pharmacy management tools, including multi-tier formularies, step therapy, and prior authorization. PCMA has been supportive of a wide-range of private and public efforts to improve the information available to consumers, clinicians, and purchasers, including:

The Agency for Healthcare Research and Quality (AHRQ) is in the midst of a multi-year comparative effectiveness review, AHRQ’s Effective Health Care Program, examining a number of drug classes and therapies that has drawn widespread praise from across the political spectrum. The link is http://effectivehealthcare.ahrq.gov/aboutUs/index.cfm.

Consumers Union has launched an initiative, “Best Buy Drugs,” delivering consumer-friendly information about competing drug therapies for a wide range of common conditions. The link is http://www.crbestbuydrugs.org/.

AARP has launched a website providing comparative information to consumers about prescription drugs from the Drug Effectiveness Review Project (DERP) at the Oregon Evidence-based Practice Center. The link is http://www.aarp.org/health/comparedrugs/

Lastly, a diverse group, the Coalition for a Competitive Pharmaceutical Marketplace, which represents employers, insurers, and others, has been out front to remind policymakers about the need for continued access to a wide range of affordable and proven drug therapies and to oppose proposals that would increase prescription drug costs for consumers and purchasers with no corresponding benefit.
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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
Charles Coté 202-207-3605

PCMA: Surveys show seniors are saving more money with new benefit

(Washington, DC)—In response to new attacks today from the drugstore lobby on the Medicare prescription drug benefit, the Pharmaceutical Care Management Association (PCMA) issued the following statement. PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

“The Medicare prescription drug benefit is working as Congress and the Administration intended: almost 40 million senior and disabled beneficiaries have access to Medicare drug coverage which is providing deep discounts on the prescription drugs they need. A recent Washington Post/ABC News poll revealed that 63 percent of seniors said they were saving money with the new program.

“Regrettably, the drugstore lobby—which earns its greatest profits from uninsured cash paying customers—continues to attack the new drug benefit and the cost-saving tools it employs. Prior to the new Medicare drug benefit, seniors—especially seniors without drug coverage—were paying some of the highest costs of all for their prescription drugs. Seniors were at the mercy of drugstores, while public programs also paid too much for drugs before the advent of Medicare Part D. According to the government’s own data from the Office of Inspector General, prior to Medicare Part D, Medicaid was shown to have overpaid pharmacists for drugs by an average of 47 percent. The federal government is now helping states adjust for these overpayments in Medicaid in order to avoid making the same mistakes in Medicare.

“In part because of proven PBM tools, researchers from the Centers for Medicare & Medicaid Services (CMS) recently estimated that seniors enrolled in Medicare drug plans are now seeing discounts averaging 27 percent â?? up markedly from earlier projections of 15 percent discounts. PCMA’s own analysis found that on average seniors are saving 35 percent on drugs purchased at a retail pharmacy compared to cash-paying customers and 46 percent for drugs purchased through mail-service pharmacies. In addition to these findings, numerous independent, government data â?? including studies from the Federal Trade Commission (FTC), the Congressional Budget Office (CBO), and the Government Accountability Office (GAO) â?? have found that PBMs and the proven tools they utilize help drive down the cost of prescription drugs.

“The drugstore lobby should consider ending their attacks on a program which offers so much vital assistance to the seniors whom they serve.”

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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
Charles Coté 202-207-3605

(Washington, DC)—Today’s announcement from researchers at the Centers for Medicare and Medicaid Services (CMS) that prescription drug spending slowed to its lowest growth rate in the past decade — driven down in large part by increased reliance on generic drugs and mail-service pharmacies — marks a turning point in the prescription drug debate and demonstrates clear pathways for policymakers and purchasers to contain costs and expand access to prescription drugs in the years ahead, the Pharmaceutical Care Management Association (PCMA) said today.

“As the old saying goes, everyone’s entitled to their own opinion, but not their own facts. It should be noted that the very FTC report that NCPA now attacks was demanded by the drugstore lobby—not PBMs—during its campaign to defeat the Medicare drug benefit and discredit its cost-saving tools.

“Ironically, after an exhaustive 18-month study, the FTC concluded that:

�· PBM-owned mail-service pharmacies provide lower drug prices than
drugstores and mail-service pharmacies owned by retail chains;

�· Average prices at PBM-owned mail-order pharmacies typically were lower
than retail-owned mail-service pharmacies and chain drugstores;

Ã?· The FTC report repeatedly notes that PBMs’ interests are aligned with those of its employer and health-plan customers; and

Ã?· The report labels the retail pharmacy lobby’s claims on these issues to be “without merit.”

“Those who can’t stomach this outcome might be advised to simply ‘move on’ instead of shining a new spotlight on credible, independent reports which undermine their most basic claims.”

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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
Charles Coté 202-207-3605

‘Level Playing Field’ Theme Puts Pharmacists on Equal Footing with Doctors, Hospitals in Medicare & 43 State Laws

(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) has launched print advertising highlighting a new pledge its member companies have made to pay Medicare pharmacy claims within 30 days, the association announced today. The 30-day pharmacy claims pledge is consistent with the way doctors and hospitals are paid under Medicare Parts A & B, 43 state laws, and federal employees’ health plans. PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

The print advertisement debuts today. The advertisement features a picture of a pharmacist, doctor and nurse, with the headline: “Medicare pays Doctors and Hospitals within 30 days. We think America’s pharmacists deserve no less.”

“PCMA member companies are committed to paying 95 percent of clean pharmacy claims in the same time frame that doctors and hospitals are paid in Medicare, which is within the 30-day government standard,” said PCMA President Mark Merritt.

At this time, there are five legislative proposals pending in the House and Senate that would mandate claims-payment standards that go far beyond the standard for doctors and hospitals in Medicare Parts A & B, 43 states, and federal employees’ health plans. PCMA has serious concerns that these proposals could impose increased costs on beneficiaries and the Medicare program and could allow for increased fraud and abuse.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605

CMS Researchers Identify Increased Use of Generics, Mail-Service Pharmacies As Two Key Drivers in Lowering Drug-Trend to 10-Year Low

(Washington, DC)—The Pharmaceutical Care Management Association (PCMA) issued the following statement in response to today’s Wall Street Journal news article on pharmacy benefit managers (PBMs), generic drugs, and mail-service pharmacies. PCMA is the national association representing PBMs, which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare:

“PBMs work closely with large national employers, labor unions, health insurers, and government programs to provide more than 200 million consumers with access to a wide range of clinically proven, cost-effective brand-name and generic drugs available through both drugstores and mail-service pharmacies. Private and public purchasers contract with PBMs because they know PBMs are a proven avenue to drug discounts averaging 25 percent and improved quality. Prior to the advent of PBMs, consumers either went without needed medications or were at the mercy of whatever drugstores and drugmakers decided to charge.

“The combination of generic drugs and mail-service pharmacies has had a powerful impact on lowering overall prescription drug costs throughout the entire health system. This past January, researchers from the Centers for Medicare & Medicaid Services (CMS) announced in Health Affairs that the rate of growth in prescription-drug spending had slowed to its lowest level in the past decade and more than 50 percent below its peak in the late 1990s.[1] Two of the four reasons cited by CMS researchers for this historic slowdown were the increased reliance on generic drugs and mail-service pharmacies.

“In addition to CMS’ findings, numerous independent government data â?? including studies from the Federal Trade Commission (FTC), the Congressional Budget Office (CBO), and the Government Accountability Office (GAO) â?? have found that PBMs and the proven tools they utilize to manage drug benefits drive down the cost of prescription drugs. In particular, the FTC’s August 2005 findings are worth noting:[2]

�· PBM-owned mail-service pharmacies provide lower drug prices than drugstores and mail-service pharmacies owned by retail chains;

�· 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; and

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

“Despite the article’s contention that PBM clients are not ’savvy enough,’ PCMA would note that PBM clients are typically the largest, most sophisticated health purchasers in America. These clients include the nation’s largest employers, unions, health insurers, and government programs. Furthermore, the PBM marketplace is very competitive and offers many different models and options â?? including the option for purchasers to forego PBMs and manage drug benefits on their own. However, this option is rarely exercised because of the tremendous cost-savings and value PBMs provide to consumers and purchasers.

“Lastly, private and public purchasers have access to the drug-pricing information they want and need as part of the contracting process. PCMA believes strongly that legislative proposals modeled after the state of Maine would increase prescription drugs by more than 10 percent. In 2006, ten states have already rejected one-size-fits-all fiduciary-disclosure bills. This is due in large part to the constant and active opposition to these bills by the very employer and health insurer communities whose interests the article purports to be advocating.”

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[1] Cynthia Smith, Cathy Cowan, Stephen Heffler, Aaron Catlin, and the National Health Accounts Team, “National Health Spending in 2004: Recent Slowdown Led by Prescription Drug Spending,” Health Affairs, January/February 2006, p. 186.

[2] Michael R. Wroblewski, et al, “Pharmacy Benefit Managers: Ownership of Mail-Order Pharmacies,” Federal Trade Commission, August 2005

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605

Moran Company Study finds Drugstore Lobby�s Agenda Would Increase Medicare Costs by at Least $9 Billion

30-Day Standard is Consistent with Medicare Parts A & B, 43 States, & FEHBP

(Washington, DC)—The Board of Directors of the Pharmaceutical Care Management Association (PCMA) today pledged that their companies will pay pharmacists for Medicare Part D pharmacy claims within 30 days of receipt of clean claims, a standard consistent with Medicare Parts A & B, 43 states, and the federal employees’ health plan. PCMA member companies are sponsors of six of the 10 national Medicare prescription drug plans and administer Part D for many other plans.

“The 30-day pledge signals Medicare drug plans’ continued commitment to fair and timely claims payments to America’s pharmacists,” said PCMA President Mark Merritt. “Working together, PBMs, drugstores, health plans, and others can make sure this new drug benefit continues to offer seniors the savings and access to the prescription drugs that they deserve. This pledge also sends a positive message to pharmacists, who have provided tremendous assistance to seniors since the start of this new benefit.”

With today’s announcement, PCMA member companies pledge to specifically:

Pay clean electronic claims within 30 days of the date of submission; and
A “clean claim” is defined to mean that the claim submitted has no defect or impropriety (including lack of substantiating documentation) or circumstance requiring special treatment that prevents timely payment.
The 30-day standard is the same payment standard that applies to doctors, hospitals, and other providers in Medicare Parts A & B. A 30-day timeframe is the pharmacy-claims standard in 43 states and is the standard applied to FEHBP, Members of Congress’ own health plan. The 30-day standard is applied to medical providers in the commercial marketplace and for business transactions and payments associated with credit cards and utilities. A 30-day standard helps improve quality, ensure accurate payments, and to prevent fraud and abuse, which costs the health care system billions of dollars annually and increases costs for consumers and purchasers.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605

(Washington, DC)—Despite efforts today by the District of Columbia to amend Title II of the DC AccessRx Act of 2004, the Pharmaceutical Care Management Association (PCMA) believes the underlying fiduciary-disclosure law remains unconstitutional because it conflicts with federal ERISA law, and, in addition, would result in a 10 percent hike in prescription drug costs for District residents and employers, the association said today.

With some reports putting forward inaccurate and/or incomplete information about today’s efforts, PCMA believes it is critical to set the record straight about what DC is doing, its impact on the DC litigation, and, lastly, on the Maine case:

1. Later today, the District of Columbia is expected to amend Title II of the DC AccessRx Act of 2004 by limiting application of the DC law to District residents and employees and altering the law’s fiduciary obligations. PCMA believes these changes do not change the underlying fact that Title II is superseded by federal ERISA law and that the measure will increase prescription drug costs in the District of Columbia.

2. Even as amended, Title II of the DC AccessRx goes much further in its reach than a similar measure approved by Maine in 2003 and currently being litigated by PCMA. As such, the amended DC law does not and will not conform to the Maine statute. The issues in the two cases remain different, and for that and other reasons, the doctrine of collateral estoppel does not apply.

3. PCMA believes that these amendments are akin to the proverbial rearranging of the deck chairs on the Titanic. DC is trying to fix an unworkable law. PCMA believes strongly that both the Maine and DC fiduciary-disclosure laws are inherently unconstitutional, as they conflict with federal ERISA law and constitute an illegal taking of trade secrets.

4. The December 2004 federal injunction blocking the District of Columbia from enforcing Title II remains intact and is expected to remain so for the foreseeable future. The federal injunction was put in place in December 2004 by US District Court Ricardo M. Urbina. In granting the injunction, Judge Urbina specifically upheld PCMA’s argument that Title II of the DC AccessRx Act of 2004 would represent an “illegal takings” of private property â?? an issue not addressed in today’s amendments by the District of Columbia. In doing so, Judge Urbina also noted that “the evidence indicates that if enforced, Title II could have the unintended effect of actually driving the PBM business and its attendant benefits out of the District of Columbia.”

5. Today’s expected efforts by the District of Columbia mean that a ruling on summary judgment in the DC case is likely to be delayed. PCMA fully expects the federal injunction to remain in place until a ruling is handed down. It is unclear when a ruling from the US District Court may be issued.

6. While PCMA continues to litigate the DC law, PCMA is pursuing a separate track with respect to the Maine law. In November 2005, the First Circuit in Boston affirmed the District Court’s upholding of the Maine fiduciary-disclosure law. Last month, PCMA filed a petition with the US Supreme Court asking the Court to review the First Circuit’s decision. PCMA expects a response from the Court before its adjournment in June.

7. A July 2004 analysis by PricewaterhouseCoopers found that the fiduciary-disclosure provisions contained within Title II of the DC AccessRx Act of 2004 would increase prescription drug costs for District consumers and employers by more than 10 percent â?? or about $600.7 billion dollars by 2014.

8. Thus far in 2006, 10 states â?? Alabama, Colorado, Connecticut, Maryland, Mississippi, New Hampshire, Oklahoma, Virginia, Washington State, and West Virginia â?? have now rejected proposals imposing fiduciary and/or disclosure requirements on PBMs. No state has enacted a fiduciary-disclosure law in 2006. In 2006, DC-style proposals have gone down to defeat in Colorado, Connecticut, Oklahoma, and Washington State. DC-style proposals are pending in New Jersey, New York, Pennsylvania, Rhode Island, and Tennessee. In 2006, two states have enacted PBM-related legislation. Mississippi has enacted a PBM prompt-pay law. Kansas has enacted a law requiring PBMs, not already licensed in the state as third-party administrators, to register with the state’s Commissioner of Insurance.

9. Numerous independent government data have concluded that one-size-fits-all public “disclosure” of drug-pricing information would increase prescription drug costs. In 2003, the Congressional Budget Office estimated that public disclosure of drug-pricing information would increase costs in the Medicare prescription drug benefit by 10 percent â?? or about $40 billion over ten years â?? and increase Medicare Part D premiums by more than 5 percent in 2006 alone. In 2004, the US Federal Trade Commission and US Department of Justice issued a joint report on competition in the health care industry stressing that the marketplace will arrive at a more optimal level of disclosure than can be accomplished through legislation.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605