Washington, DC; 08.19.04 — Mark Merritt, President of the Pharmaceutical Care Management Association (PCMA) released the following statement regarding today’s release of draft Medicare formulary model guidelines from the US Pharmacopeial Convention (USP). PCMA is the national association representing America’s pharmacy benefit managers (PBMs):

“A guiding principle of the bipartisan Medicare Modernization Act (MMA) is that America’s seniors deserve a Medicare prescription drug benefit that builds upon PBMs’ proven success in the commercial marketplace in striking the right balance between cost, access, and quality.

“In the commercial marketplace, PBMs rely upon a wide range of tools and techniques â?? including formularies â?? to negotiate discounts with drug manufacturers. Employers, unions, health plans, and other purchasers typically offer prescription drug plans with coverage for 50 to 100 therapeutic classes. According to a recent report by PricewaterhouseCoopers, these tools help drive drug discounts that lower the cost of prescription drugs by an average 25 percent in the commercial marketplace. PricewaterhouseCoopers estimates that over the next decade PBMs will save $1.3 trillion on prescription drug costs for consumers and employers.

“Today’s draft model guidelines from the USP call for Medicare formularies that cover 146 therapeutic categories and classes. If embraced, such an approach would move far beyond how formularies are structured currently in the commercial marketplace and could have the unintended consequence of increasing costs and jeopardizing a workable Medicare prescription drug benefit for seniors.

“Even more troubling are back-door efforts by the drug manufacturers and their front groups to have 300 or more therapeutic classes of drugs covered in the Medicare formulary. This approach would undermine competition in the Medicare prescription drug benefit and be tantamount to a blank check for the drug manufacturers. Over the long-term, this structure could bankrupt the Medicare program and diminish the very drug benefit seniors have waited so long to receive.

“Today’s draft model guidelines from USP represent an important first step. As this process continues, PCMA and its member companies look forward to working with beneficiaries, policymakers, and others to structure a workable Medicare prescription drug benefit that balances beneficiary access and cost containment.”

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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