PCMA Urges CMS to Protect Financial Health of Pharmacies During IRA Implementation

December 10, 2024

EGWP Medicare

On Nov. 4, PCMA called on CMS to prioritize a regulatory model where pharmacies are not at “the mercy of big drug companies” who can delay reimbursements for Medicare negotiated drugs under final Inflation Reduction Act (IRA) guidance. The group argued that “Pharmacies should not be exposed to potential financial shortfalls because of a [drug] manufacturer’s preference on how to implement a statutory obligation.” If pharmacies aren’t protected, 90% of pharmacists recently surveyed by the National Community Pharmacy Association stated they will not dispense the 10 prescription drugs for which the government recently negotiated prices.

The law holds that drug companies are solely responsible to reimburse pharmacies for any difference between the price they acquire the drugs for and the new Medicare price set by the government. PCMA is calling on CMS to develop a simpler, fairer model for pharmacies and the patients they serve to ensure that their access to prescription drugs is uninterrupted. PCMA said PBMs have offered recommendations for how this can happen and stand ready to be collaborative partners in ensuring these very serious consequences are addressed appropriately.

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Congress Stares Down Dec. 20 Deadline to Extend Federal Funding

Congressional leaders are reportedly planning to extend current federal funding via a continuing resolution (CR) for a short period of time into 2025. This would set up another funding deadline for the incoming Trump Administration to negotiate early in the year. There is also a concurrent negotiation regarding which policies will be “attached” to the […]
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December 10, 2024

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HHS OIG Report Finds Half of Hospitals Fail to Comply with Transparency Law

A new report by HHS’s Office of Inspector General (OIG) finds widespread failure among hospitals to comply with federal price transparency law, with almost half of 100 surveyed hospitals not fully compliant. The report found that many hospitals are not publishing their prices in accordance with the law, with some hospitals saying they would rather […]
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December 10, 2024

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Energy and Commerce Chair Sends Letters to FTC, Four Other Agencies to End Partisan Work

On Nov. 6, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) sent letters to five federal agencies, including the Federal Trade Commission (FTC), urging the Biden-Harris administration appointees to abandon partisan efforts. She noted that the election results mean the agency leadership will soon change and, “As a traditional part of the peaceful […]
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December 10, 2024

EGWP marketplace medicaid Medicare

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