“PBM” Reform and Defending Patient Access

79%

Pharmacists Most Credible on Prescription-Drug Savings

say pharmacists are “very credible” or “somewhat credible” sources when it comes to information about how to save money on prescription drugs – ranking them highest among those tested (others tested include doctors, hospitals, health insurance companies, pharmaceutical companies). 

Pharmacists Most Credible on Prescription-Drug Savings

79%

say pharmacists are “very credible” or “somewhat credible” sources when it comes to information about how to save money on prescription drugs – ranking them highest among those tested (others tested include doctors, hospitals, health insurance companies, pharmaceutical companies). 

Morning Consult conducted this poll between December 7-December 12, 2022, among a sample of 20,010 Adults. The interviews were conducted online and the data were weighted to approximate a target sample of Adults based on gender, age, race, educational attainment, and region. Results from the full survey have a margin of error of plus or minus 1 percentage points. NACDS commissioned the poll.

Stop Manipulation of Drug Prices, Medication Access, & Pharmacy Freedom

“PBM”s make $315 billion annually – rising to $740 billion by 2029. See how they do it at the expense of patients, pharmacies, and others. And how to fix it.

Stop PBM Manipulation
Principles of PBM Reform
PBM Reform News
STOP PBM Manipulation

These are essential principles for comprehensive PBM reform – to help stop PBMs’ manipulation and to stand up for patients’ pharmacy access and for pharmacies’ survival:

Stop explosive retroactive fees.

Stop PBMs and payers from using “DIR fees” and other tactics to grab back the payments made and owed to pharmacies – often many months after the fact and often resulting in below-cost pharmacy reimbursement.

Adopt a rate floor that prevents PBMs and payers from reimbursing pharmacies below the true cost of acquiring and dispensing prescription drugs.

Standardize performance measures to help improve patient outcomes and reduce costs – rather than allowing PBMs and payers to play “gotcha” with pharmacies using arbitrary measures and exorbitant fees.

Prevent PBMs and payers from defining “specialty drugs” in ways that steer patients with rare or complex diseases away from their preferred pharmacy and toward another pharmacy – including those owned by the PBMs and payers.

Prohibit PBMs and payers from forcing patients to use mail-order pharmacies – including those owned by the PBMs and payers – and prohibit them from imposing penalties on patients for choosing a convenient and trusted pharmacy in their neighborhood.

Require PBMs and payers to include in their networks all pharmacies willing to accept terms and conditions established by the PBM.

Bring efficiency, transparency, and standardization to the processes by which PBMs audit pharmacies without sacrificing continuity of care.

Prioritize the implementation, enforcement, and oversight of PBM reform laws – to maximize results for patients and fairness for pharmacies and other stakeholders, and to ensure laws are not undermined by inaction of PBMs or of government.

Drilling Down: Stopping “DIR” Fees

“DIR” Fee White Paper Describes
“Lack of Clarity, Fairness and Transparency”

DIR Fees Growing to Over 6% of Medicare Part D Sales

DOWNLOAD WHITE PAPER
Inmar DIR White Paper

Resources

DIR Fees FAQ
FAQ – DIR Fees
February 13th Comments
DIR Fees FAQ
News – DIR Fee Reform

“DIR” Fee Relief: Reducing Costs, Improving Health

DIR reform reduces patient cost sharing for medications.

Reforming pharmacy DIR fees will save patients $7.1 to $9.2 billion over 10 years.

DIR reform increases the likelihood that patients take their medications as prescribed.

A review of 160 studies revealed that medication adherence significantly decreases as the medication cost to the patient increases.

DIR reform allows patients to stay healthier, and avoid more costly care.

Disease-specific cost of non-adherence is estimated up to $44,190 per person, and costs attributed to ʻall causesʼ non-adherence is estimated up to $52,341 per person.

DIR reform lowers overall healthcare costs, saving the federal government money.

If 25% of hypertension patients who were non-adherent became adherent, Medicare could save nearly $14 billion annually, averting over 100,000 emergency room visits and 7 million inpatient hospital days.

DIR Fee Relief Flyer