Congress follows up with CMS on generic transparency

WASHINGTON – Congress earlier this week followed up with the Centers for Medicare and Medicaid Services on transparency measures governing generic prescription drug payments in Medicare Part D plans for 2016. 

 

All told, 11 members of the House of Representatives signed a letter earlier this week, including Reps. Rick Allen, R-Ga., Rod Blum, R-Iowa, Buddy Carter, R-Ga., Doug Collins, R-Ga., Morgan Griffith, R-Va., Walter Jones, R-N.C., Dave Loebsack, D-Iowa, John Sarbanes. D-Md., Austin Scott, R-Ga., Peter Welch. D-Vt. and Lynn Westmoreland, R-Ga. 

 

“Generic prescription drugs account for over 80% of drugs dispensed, but details surrounding the reimbursement system for these medications is unknown to pharmacists and raises serious questions as to whether Medicare is overpaying the plan drug middlemen,” the Representatives wrote in the letter. The letter goes on to explain that there is a need for oversight: “As you begin preparing to enforce these provisions please share with us your plans to ensure ordered implementation. Many states have passed MAC Transparency laws and have struggled to enforce them effectively.”

 

The letter also highlighted a MAC reform bill pending in the U.S. House of Representatives - H.R. 244, The MAC Transparency Act – introduced by Reps. Collins and Loebsack as a possible framework for additional measures that can be implemented for greater fairness in generic drug pricing and transparency. 

 

“Independent community pharmacies have struggled to remain financially viable due to the discrepancy between the soaring acquisition costs for many generic prescription drugs and the outdated and low reimbursements they receive from pharmacy benefit manager corporations," stated Douglas Hoey, CEO of the National Community Pharmacists Association. "That’s why we were heartened when CMS made a commitment to not only ensure generic drug reimbursements are updated by PBM corporations on a weekly basis to reflect market prices, but also to provide information as to how those reimbursements are determined for Medicare Part D next year," he said. “Needed guidance from CMS that will determine how PBM corporations must follow these new requirements is still pending, which is why a bipartisan coalition from the U.S. House of Representatives took the opportunity to remind CMS why this change is badly needed."

  

Transparency provisions for maximum allowable costs were included by CMS in its final rule issued in May 2014, but the regulatory framework that will determine the implementation of such provisions has not been released.