PCMA: Cost of Drugstore Lobby’s Agenda Tops $10 Billion
(Washington, DC)—The cost of legislation currently before Congress implementing the drugstore lobby’s special-interest agenda has reached at least $10 billion Ă¢?? and is likely to go far higher once the final numbers are tallied, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which drive prescription drug costs lower for more than 200 million Americans with health coverage provided through Fortune 500 employers, health insurers, labor unions, and Medicare.
PCMA has serious concerns that the drugstore lobby’s agenda on Capitol Hill would result in working families, seniors, military personnel, and taxpayers paying far more for prescription drugs with no corresponding benefit. On just a handful of key issues Ă¢?? supporting prompt pay and medication therapy management legislation and opposing Medicaid reform and the mail-order pharmacy option, the cost to consumers and the federal government would top $10 billion:
1. Supporting Medicare Prompt Pay/Medication Therapy Management Mandate. Cost: At least $9.4 billion. A key priority of the drugstore lobby is to implement legislation mandating unprecedented timeframes for payment of pharmacy claims in Medicare Part D and rigid and inflexible rules on how Part D plans structure their medication therapy management (MTM) programs. According to an analysis of a proposal sponsored by Senator Thad Cochran (R-Miss.) and conducted by Steve Lieberman at the Moran Company, this proposal would increase costs to seniors and the Medicare program by at least $9.4 billion over ten years, representing $7.7 billion in higher costs to the federal government and $1.7 billion in higher beneficiary premiums. Mr. Lieberman is the former lead health analyst at the Congressional Budget Office.
2. Opposing the Administration’s Proposed Adjustment of Medicaid Overpayments to Pharmacies. Cost: At Least $1.3 billion. Medicaid overpayments to pharmacies are well-documented. According to a June 2005 report from the HHS Office of Inspector General, Medicaid has overpaid pharmacies by an average of 47 percent. In its budget proposal, the Administration has proposed adjusting for these overpayments to pharmacists and saving taxpayers $1.3 billion. The drugstore lobby has vowed to defeat efforts aimed at adjusting for Medicaid overpayments to pharmacies.
3. Opposing the Mail-Order Pharmacy Option in TRICARE. Cost: $1.5 billion. The Congressional Budget Office (CBO) estimates that the Department of Defense will save $1.5 billion from 2007-2016 by moving toward the mail-order pharmacy option in the TRICARE program. According to a June 9, 2006 analysis, “CBO estimates that the savings from transferring prescriptions from retail pharmacies to the TRICARE mail-order program (TMOP) would be about $54 million in 2007, $593 million over the 2007-2011 period, and $1.5 billion over the 2007-2016 period.” Regrettably, the drugstore lobby is fighting to keep drugs costs higher for the nation’s military, dependents, and retirees.
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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