NCPA gets behind Drug Transparency in Medicaid Act 

ALEXANDRIA, Va. – The National Community Pharmacists Association supports bipartisan legislation reintroduced March 17 to improve transparency and prevent the use of “spread pricing” in Medicare managed care programs. Spread pricing is when pharmacy benefit managers overbill the state or Medicaid managed care programs, under-reimburse pharmacies for medications dispensed and retain the difference, the association says. A broad ban on these practices would save the federal government more than $1 billion over the next 10 years, with state governments also saving hundreds of millions of dollars in Medicaid costs, it says. “Through spread pricing in Medicaid alone, PBMs can hoard hundreds of millions of dollars each year,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “That this tactic hasn’t yet been banned is good for the mega-middlemen, but terrible for the beneficiaries and taxpayers left paying inflating prescription drug costs as a result.” In addition to banning spread pricing, the Drug Transparency in Medicaid Act would also require pharmacy reimbursements in all state Medicaid managed care programs to be at a rate of pharmacy’s average acquisition costs based on the National Average Drug Acquisition Cost survey, plus the state’s Medicaid fee for service dispensing fee; limit payments to PBMs to solely administrative fees; and mandate NADAC reporting to CMS by all pharmacies participating in state Medicaid programs. The legislation was reintroduced by Reps. Buddy Carter, R-Ga.; Vicente Gonzalez, D-Texas; Rick Allen, R-Ga.; Jake Auchincloss, D-Mass.; Elise Stefanik, R-N.Y., and Deborah Ross, D-N.C.