NCPA cites real-world examples of generic pricing pain
ALEXANDRIA, Va. — The National Community Pharmacists Association is ramping up its support of the MAC Transparency Act (H.R. 244) with real-world examples of how independents are suffering from below-cost generic drug reimbursements.
“Independent community pharmacies should not be consistently underpaid for the products and services they offer,” NCPA CEO Douglas Hoey said. “Unfortunately, the ‘buy high-sell low’ dynamic has regrettably become commonplace for these small business health providers, who absorb financial losses for many generic drugs because PBM corporations do not disclose reimbursement benchmarks to either pharmacies or the plan sponsors who hire them, and fail to react adequately to acquisition costs that can soar by as much as 1,000 percent, virtually overnight," he said. “Without greater transparency and timely updates from PBM corporations, independent community pharmacies will be forced make tough decisions that do not benefit their patients. These include no longer dispensing certain generic drugs to avoid such losses or cutting staff or hours or even closing their business altogether. Something has to give because the status quo is unsustainable.”
H.R. 244 would help address this problem by requiring PBMs to update their generic benchmarks every seven days and increasing transparency into generic drug transactions by PBM corporations.
NCPA recently asked its members for examples detailing the costs they incurred to acquire drugs versus the reimbursement they received when they filled the prescriptions. To date 130 pharmacies representing 105 Congressional districts in 35 states responded.
What follows are some examples recently provided by NCPA member pharmacies:
On June 5 a patient was given leflunomide, which is used to halt the progression of rheumatoid arthritis. The pharmacy’s acquisition cost was $492.17 and the PBM reimbursement was $17.68, which is a difference of $474.49;
On May 29 the antipsychotic aripiprazole was given to a patient. The pharmacy’s acquisition cost was $416.25 and the PBM reimbursement was $97.28, which is a difference of $318.97; and
On June 1 a patient was given duloxetine, which treats major depression, anxiety disorder and chronic pain. The pharmacy’s acquisition cost was $339.87 and the PBM reimbursement was $81.28, which is a difference of $258.69.
These claims follow a recent NCPA member survey on this issue, which showed the generic drug reimbursement discrepancies have gotten worse. Separately, an AARP Public Policy Institute report also concluded that prices have increased substantially for a number generic drugs.