Published in Endpoints News
The Centers for Medicare and Medicaid Services has never played a significant role in regulating pharmacy benefit managers, the middlemen that have historically relied on high drug prices for profits. But the government spending package that’s nearing the finish line this week is poised to change that.
“You’re turning around the Titanic here,” Jesse Dresser, a partner in the law firm Frier Levitt’s life sciences department, told Endpoints News. Dresser helped Congress draft the PBM portions of the bill.
The bill also requires CMS to investigate and enforce any PBM complaints from pharmacies, making “a complete 180” from past practices on PBMs, Dresser said. He said CMS may have to hire new experts to help collect new data on PBMs and do research in order to be able to set appropriate standards.
“So if CVS Caremark improperly retains money at a PBM level and has to disgorge it to the Part D level, it’s just kind of moving it from one pocket to the other. So there’s a big question mark as to what this is going to look like,” Dresser said.
A spokesperson for CVS Health said in a statement that “[i]n this spending bill, Pharma wins. To drugmakers’ credit, they’ve funded a decades’ long lobbying and advertising campaign to try to shift the blame for rising drug prices to anyone but them.”
Dresser also noted that PBMs “are very good at playing games,” adding that there is a concern that PBMs will “double down” on other components within the pharma supply chain or lobby CMS when it begins setting new standards for PBMs in ways that make them less effective.
Read more: https://endpoints.news/turning-around-the-titanic-how-the-incoming-pbm-reforms-will-transform-cms/
