PCMA Highlights How Pharmacy Network Designs Save Money

October 8, 2024

EGWP Medicare

The Pharmaceutical Care Management Association (PCMA) recently highlighted how PBM-managed networks lower costs, provide health plan sponsors the ability to offer lower-cost, higher quality and more convenient pharmacy options, and debunk claims that pharmacy benefit companies are reimbursing independent pharmacies at lower rates than other retail pharmacies, according to repeated expert analysis, academic studies, and non-political government agency reports.

PCMA noted that there have been many common misconceptions surrounding pharmacy networks, exacerbated by flawed reports, such as the FTC’s recent interim report. In the blog, PCMA reiterated the following facts:

  • Network design: According to a study from the University of Pennsylvania’s Wharton School of Business, preferred pharmacy networks in just the Medicare Part D program result in millions of dollars in savings for seniors, Part D plans, and taxpayers. The study found that plans that use pharmacy networks in the program saw a 1% decrease in costs.
  • Steering: Mail-order pharmacies are projected to save $23.5 billion over the next 10 years, and specialty pharmacies will save an estimated $250 billion over a ten-year period 2023-2032.
  • Pharmacy reimbursement: Reimbursement rates paid to independent pharmacies are generally higher than the reimbursement rates paid to non-affiliated chain pharmacies, for both non-specialty branded drugs (4% higher for independents) and non-specialty generic drugs (24% higher for independents). Additionally, when comparing the total payments by plan sponsors and members, payments for all drugs dispensed at affiliated pharmacies are roughly 4% lower than payments for the same drugs at non- affiliated pharmacies.

legislation

House Judiciary Subcommittee Holds Hearing on the Role of PBMs

On Sept. 11, the House Judiciary Subcommittee on the Administrative State, Regulatory Reform, and Antitrust held a hearing titled, “The Role of Pharmacy Benefit Managers,” featuring academic witnesses. The hearing focused on transparency, affordability, and access, as well as the relationship between PBMs and independent pharmacies. Witnesses highlighted the critical role of PBMs in the […]
read more >

October 8, 2024

EGWP marketplace medicaid Medicare

Initiatives

House Education and the Workforce Committee Holds Hearing in Honor of ERISA 50th Anniversary

On Sept. 10, the House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions held a hearing titled, “ERISA’s 50th Anniversary: The Value of Employer-Sponsored Health Benefits.” Policy experts and advocates representing large employers, small business owners, and consumers discussed potential ways to strengthen the Employee Retirement Income Security Act (ERISA) and employer-sponsored coverage. […]
read more >

October 8, 2024

EGWP Medicare

legislation

Alaska Governor Approves PBM Regulation

After delaying a decision for several months, Alaska Gov. Mike Dunleavy (R) signed HB 226, an anti-PBM bill that passed by the legislature earlier this year. The bill contains problematic language that could ultimately raise costs and reduce choice for employers and consumers. Those provisions include restrictions on the use of white bagging and home […]
read more >

October 8, 2024

EGWP marketplace medicaid Medicare

You may also like