Merritt: ‘Part D Plans Delivering Broad Access, Deep Savings for Seniors & Disabled,
While Reining In Overall Program Costs’
PCMA Outlines Additional Policy Options for Improving Medicare Part D

(Washington, DC)— Testifying today before the House Oversight and Government Reform Committee, Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt reported how Medicare prescription drug plans (PDPs) and the pharmacy benefit managers (PBMs) who administer them are generating broad access, driving deep discounts on prescriptions for America’s seniors and disabled beneficiaries in Part D, and reining in overall program costs.  In addition, Mr. Merritt offered the Committee additional policy options for improving Medicare Part D.

“Working within the competitive Part D framework, PBMs offer Medicare and its beneficiaries value by using proven tools and strategies that both rein in drug spending and provide a high-quality prescription drug benefit,” said Mr. Merritt.  “These tools—pioneered by PBMs—include increasing generic utilization, improving formulary compliance rates, and encouraging the use of lower-cost delivery channels, such as the mail-service pharmacy option.”

As part of his testimony, Mr. Merritt urged policymakers to consider other options to increase savings and access for Medicare Part D beneficiaries, including:

• Establishing a clear regulatory pathway for biogenerics;
• Building upon the groundbreaking new e-prescribing incentives that were just enacted as part of the “Medicare Improvements for Patients and Providers Act”; and
• Taking a closer look at the six classes of clinical concern and the associated cost implications on drugs used by dual eligibles.  This policy does not improve access but does make it difficult for PBMs to negotiate rebates for drugs in those classes which can account for more than 40 percent of dual-related spending.

In Part D, PBMs and plan sponsors have reduced overall program costs by 30 percent below government projections, offered beneficiaries lower-than-expected premiums, and generated high levels of generic utilization, while providing broad choice of drugs and access to over 60,000 pharmacies.  In addition, overall savings of PDPs in Part D are also comparable to levels achieved by PBMs in the Federal Employees Health Benefits Program (FEHBP), according to analysis conducted by PricewaterhouseCoopers (PwC).

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(Washington, DC)— The Pharmaceutical Care Management Association (PCMA) released the following statement on Senate passage of the Medicare bill, which includes a provision that requires physicians to use electronic prescribing (e-prescribing) in Medicare:

“The inclusion of an e-prescribing requirement in Medicare is a major victory for America’s seniors.  From a patient’s perspective, e-prescribing is the most important issue in the Medicare bill because it saves lives and saves money.  This is a historic step forward for e-prescribing as the new requirement in Medicare will now lead to broader adoption of overall health care information technology.

“We are also pleased that both the effective date of the AMP payment cut as well as the date for publication of AMP data have been delayed until September 2009.

“However, PCMA continues to oppose other special interest provisions which would pay independent pharmacists twice as fast as all other Medicare providers.  This will increase costs and provide no added benefit for seniors.”

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.