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.

Initiatives

Calls grow for Drug Patent reform

In a recent blog post, the Pharmaceutical Care Management Association (PCMA) highlighted increased attention to pharmaceutical companies’ abuse of drug patents. Last month, the Supreme Court unanimously ruled in favor of a generic drugmaker in a “skinny labeling” case, a victory for patients. Skinny labels allow generic and biosimilar competitors to launch products for non-patented indications, helping accelerate […]
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August 11, 2026

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perspectives

AHIP calls for Bipartisan reform to address health care cost drivers

On July 23, AHIP President and CEO Mike Tuffin wrote an opinion piece in The New York Times saying, “common-sense bipartisan reforms are needed to promote competition in care delivery and prescription drugs, protect consumers from providers and drugmakers’ anticompetitive practices and transition away from the perverse incentives of fee-for-service medicine.” Tuffin notes that health […]
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EGWP marketplace medicaid Medicare

Solutions

PCMA urges preserving patient access and flexibility in new fertility benefits rule

PCMA recently submitted comments to HHS, DOL, and the Treasury (the Departments) in response to the proposed rule establishing a new category of limited excepted benefits for fertility services. PCMA supports the Departments’ goal of expanding access to fertility care while encouraging employer innovation but urged several targeted refinements to ensure the framework is operationally […]
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August 11, 2026

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