Expect Drug Pricing Proposals to Cause Major Disruption, Warn PBM Policy Forum Speakers

| Brittany McCullough
Prescription pill packets on top of US bills

With the ongoing debate about the high cost of prescription drugs and the role that PBMs play in managing this cost, the Pharmaceutical Care Management Association’s (PCMA) annual PBM Policy Forum couldn’t have been timelier.

Perhaps the most important take away from the event held on April 19, 2018, was that the Trump Administration plans to address the crippling effect of markedly high drug prices in some form of executive or regulatory action relatively soon. The President’s upcoming speech on drug prices (tentatively scheduled for May 8) is expected to be coupled with the release of a request for information (RFI) from the U.S. Department of Health and Human Services (HHS) on a variety of drug pricing proposals.

Since the upcoming proposals are not yet publicly known, speakers at the forum couldn’t give any real commentary on them, but, some did speculate that the proposals might cause major disruption to the industry.

The speaker panel from the PBM Policy Forum included a wide variety of stakeholders including Congressional staffers, executive level leadership from specialty pharmacies and health plans, state legislators, and top representatives from HHS, including Scott Gottlieb, current Commissioner of the U.S. Food & Drug Administration (FDA).

Here are some of the highlights:

  • Congress is waiting to see what guidance the President gives in his upcoming speech on drug prices before drafting and releasing legislation
  • Although Congress is currently focused on the opioid epidemic, drug pricing provisions might be rolled up into a comprehensive bill
  • The market dynamics surrounding the pharmacy world have drastically changed over the last 10 years due to the rise in pharmaceutical costs and increase in high deductible health plans  
  • There is a strong concern about the viability of community pharmacies in the current market but they serve an important role
  • There is a lack of education regarding what a PBM is amongst the general public 
  • The push towards value-based care transformation will continue and a major component of this is increasing transparency and reducing costs
  • The high cost of specialty drugs is in part due to a lack of competition in the market from biosimilars and generics
  • Manufacturers have been taking advantage of Risk Evaluation and Mitigation Strategy (REMS) protocols to ward off biosimilars and generics from entering the market
  • The Trump Administration is considering moving drugs covered under Medicare Part B to Part D which will reduce drug costs by requiring the prices of formerly Part B drugs to now be negotiated.

Although Congress and the Trump Administration are currently focused on combatting the opioid epidemic, one should expect action on drug prices very soon.

Brittany McCullough photo

Brittany McCullough, Health Policy Specialist.

Brittany McCullough, URAC's health policy specialist, focuses on tracking and analyzing legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external engagement. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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