National Coalition Launched to Ensure Fair PBM Audit Practices and Adequate Protections for Patients and Pharmacies

PBM Reform Coalition will pursue commonsense reforms to ensure audits are conducted with integrity; reimbursement rates are fair, consistent, and transparent; and patient information used by PBMs participating in Medicare Part D is protected.

WASHINGTON, July 9, 2013 /PRNewswire-USNewswire/ -- Pharmacy Choice and Access NOW (PCAN) today announced the launch of a new project aimed at ensuring fair and reasonable pharmacy audit standards associated with prescription drug claims paid under the Medicare Part D program. This effort seeks to protect patients and pharmacies from unfair audit conduct and practices of some pharmacy benefit management (PBM) companies, and to ensure that audits are performed with integrity and with adequate due process. This new PCAN project also highlights the need for federal legislation to address inconsistent and non-transparent reimbursement rates, and to tackle the problem of alleged improper use of patient information. 

The "PBM Reform Coalition" will explain to policymakers, the public, and the media the need for clear and consistent audit standards. With the appropriate audit standards in place, the focus of audits will return to their intended purpose, which is  rooting out fraud, waste, and abuse. The Coalition will provide examples of the negative impact of improper audit practices by some PBMs, which are not geared toward fighting fraud, and do clearly demonstrate the need for federal legislation.

Coalition members include the Food Marketing Institute (FMI); GeriMed; H-E-B; the National Association of Chain Drug Stores (NACDS); the National Community Pharmacists Association (NCPA); Omnicare; Pharmacy Choice and Access NOW (PCAN); PharMerica and Walgreens.

"Without sufficient regulation or oversight, some PBMs have been largely playing by their own rules, engaging in questionable business practices that are hurting taxpayers as well as patients and their pharmacies. And it's time for this to stop," said Dennis F. Wiesner, a Texas pharmacist with over forty years experience in community pharmacy, and spokesman for the coalition.  "We look forward to working with policymakers and others to advance appropriate reform measures that establish standards that protect all parties – measures that keep health care costs down, preserve patient choice, and allow pharmacies to remain focused on their number one priority, providing accessible quality healthcare to their patients."

PBMs are the largely unregulated drug middlemen that manage prescription drug benefit programs for employers, unions, health plans and other payers. They were created to help control the cost of drug coverage, but as they have increased in terms of size and power, their business model has gone from one aimed at helping insurance plans and employers realize cost savings to one primarily aimed at maximizing profits.  All too often, this focus on profits has resulted in questionable conduct that has had a negative impact on community pharmacies and the patients they serve.

"With health care costs on the rise, most in the industry are doing whatever they can to keep costs down for patients and providers.  Meanwhile, some PBMs haven't skipped a beat and continue using the system to increase their own profits," Wiesner continued.  "This type of behavior is ultimately destructive to patients as well as community pharmacies and the essential health care services they provide.  It's unacceptable and reform is needed now."

As part of its launch, the coalition announced its support for The Medicare Prescription Drug Program Integrity and Transparency Act (S.867), legislation that creates PBM fair audit standards, ensures transparency of payment methodology to pharmacies, and requires that recoupment of funds (via audits) are returned to Medicare.  The coalition urges Members of Congress to support the bipartisan bill. 

For more information, visit http://www.rxchoiceandaccess.com.

The PBM Reform Coalition is a project of Pharmacy Choice and Access Now (PCAN).

Pharmacy Choice & Access NOW (PCAN) is a coalition of consumers, local business and pharmacists across the nation committed to preserving quality and affordable health care and pharmacy services for patients.  PCAN members are committed to providing the most cost effective solutions in the areas of health care and pharmacy services to enable states around the country to help solve their budget woes while maintaining quality care for children, families and other Medicaid-served populations.  You can join the conversation on Facebook (Pharmacy Choice and Access Now) and Twitter (@RxPCAN)

For more information, please visit www.RxChoiceandAccess.com.  

SOURCE Pharmacy Choice and Access Now