CORRECT: Drug-Benefit Industry Balks At Disclosure Measure
September 29 2009 - 11:13AM
Dow Jones News
The pharmacy benefit management industry Friday criticized a
health-care bill provision to require more disclosure from PBMs,
saying the measure would raise rather than lower prescription drug
costs.
The Senate Finance Committee adopted an amendment by Sen. Maria
Cantwell, D-Wash., to require disclosure of certain information
from PBMs participating in health insurance exchanges or the
Medicare Part D drug program.
PBMs handle prescription drug benefits for employer and
health-plan clients and the individuals covered by those plans,
negotiating prices and discounts with drug makers and pharmacies.
Cantwell's amendment would require PBMs to disclose the difference
between what plans pay them for drugs and the amount the PBMs
actually pay to purchase the drugs from retail and mail-order
pharmacies.
The Pharmaceutical Care Management Association, which represents
PBMs such as Medco Health Solutions Inc. (MHS), Express Scripts
Inc. (ESRX) and CVS Caremark Corp. (CVS), said the measure would
give drug makers more pricing power while not helping
consumers.
PBMs "believe strongly in the principle of transparency and
empowering payers to make informed health-care purchasing decisions
resulting in lower prescription drug costs and higher quality.
Regrettably, today's amendment moves the health-care system in the
opposite direction," PCMA President Mark Merritt said in a
statement. "The Cantwell amendment would force PBMs to disclose
information that would give manufacturers and drug stores more
leverage in drug-price negotiations."
The amendment would require PBMs to share information with the
Secretary of Health and Human Services and with health plans they
contract with through the Medicare prescription-drug-benefit
program or the health insurance exchanges proposed by the
underlying health-overhaul bill. The information is to be
considered confidential.
Among other data, PBMs would have to disclose the aggregate
amount and types of rebates and price concessions they negotiate on
behalf of a plan and the aggregate amount passed along to the plan
sponsor.
"I think there's a slippery-slope issue and also the issue of
confidentiality has always been in question," Merritt told Dow
Jones Newswires. "This kind of transparency has never reduced
prices," according to serious economists who have looked at it, he
added.
The House Energy and Commerce Committee previously approved a
similar provision in its health-care overhaul bill.
"PBM business practices and pricing have always been somewhat
opaque and increased disclosure could negatively impact margins,"
said Wells Fargo analyst Matt Perry. "Pricing information could
help pharma companies and retail pharmacy chains get better pricing
out of PBMs, which could decrease the value that PBMs are able to
provide to their employer customers, as well as hurt PBM margins."
He noted that the measure is a long way from being written into
law.
Earlier this week, the National Community Pharmacists
Association voiced support for the measure, saying it would drive
down health-care costs by lifting "a shroud of secrecy" that has
allowed PBMs "to pocket large portions of both the transactions
they process as well as the rebates paid by manufacturers."
PBMs could benefit from other aspects of a revision of the
nation's health laws. Provisions to expand health coverage to
millions more Americans and to promote the use of generic drugs are
considered positive for the industry.
Medco recently traded down less than 1% to $54.88 and Express
Scripts was off 1.3% at $76.99. CVS Caremark, which also operates
the national CVS drug-store chain, was up 3 cents at $35.23.
-By Dinah Wisenberg Brin, Dow Jones Newswires; 215-656-8285;
dinah.brin@dowjones.com
(Patrick Yoest contributed to this article.)