Adding Facts to a Fact Sheet

Jan 27, 2017
Setting the record straight on how PBMs help save government money on prescription drugs, and how we help improve access to care.
Tags
  • Medicaid
  • Medicare

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There have been some incorrect interpretations of a recent fact sheet posted by the Centers for Medicare & Medicaid Services (CMS), and we wanted to set the record straight on how PBMs help save government money on prescription drugs, and how we help improve access to care.

First, a word on DIR (Direct and Indirect Remuneration) fees: Pharmacies can get incentives for delivering quality care, for example by achieving certain adherence targets. Pharmacies that agree to DIR fees know their goals and get feedback on where they stand vs. their competitors. When reading the CMS fact sheet, it’s important to consider the following:

  • DIR lowers cost. The proof is the fact that the premiums have stayed flat (low single-digit increases) in an environment with escalating drug prices. Figure 3 is very telling, as it shows that PBMs are doing their job to lower total costs. Pharmacies provide deeper discounts with DIR.
  • A different headline for the same fact sheet could be, “Part D is Working as Designed.” Plans and PBMs are negotiating discounts from drug makers and pharmacies to get the best deals for the plans they offer. The report finds that as drug prices went up, member premiums went down. That’s more evidence that our negotiations with drug makers and drug stores are working to the advantage of patients and payers.
  • Among the omissions from the fact sheet, DIR fees improve quality (and thus star ratings) by holding pharmacies accountable for achieving quality metrics.

Part D is a completely transparent marketplace where the government’s own findings are that these discounts “reduce beneficiary premiums and some government costs.”

In addition, we have seen some questions about rebates. It’s worth noting that rebates are created by drug makers, offered by drug makers and expanded by drug makers. Rebates do not raise drug prices, drug makers raise drug prices. Our clients, 100% of them, decide exactly how rebates are used and whether they are shared with their PBM.

We are proud of the work we do to drive down the cost of pharmacy care and to put medicine within the reach of people who need it.

Author Bio

Lab Staff
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