NCPA calls for PBM transparency in health insurance exchanges

August 15, 2011

Pharmacy benefit managers should be required to be more transparent in health insurance exchanges, the National Community Pharmacists Association asserted in comments recently submitted to the U.S. Office of Personnel Management (OPM).

Pharmacy benefit managers (PBMs) should be required to be more transparent in health insurance exchanges, the National Community Pharmacists Association (NCPA) asserted in comments recently submitted to the U.S. Office of Personnel Management (OPM).

The OPM is responsible for contracting with at least 2 multistate plans that will offer coverage through exchanges, which come online in 2014. “Successful healthcare reform places a premium on transparency, and nowhere is that needed more than in the administration of prescription drug services by the PBM industry,” said B. Douglas Hoey, RPh, NCPA executive vice president and CEO. “The federal health reform law includes just such a provision in the state healthcare exchanges … that allow health plan sponsors to actually ensure PBM promises of efficiency and savings are occurring,” he added.

NCPA provided OPM with several recommendations pertaining to healthcare exchanges. They included:

  • OPM should implement the PBM transparency provisions that the agency recently instituted for the Federal Employees Health Benefit Plan (FEHBP) in the multistate exchange plans.
  • In order to ensure adequate access to pharmacy services in hard-to-serve regions, OPM should allow participation of any willing pharmacies in multistate exchange plans.
  • In terms of pharmacy network adequacy, OPM should not equate access to mail-order pharmacy with access to face-to-face interaction with a pharmacist.
  • OPM should require qualified health plans in multistate exchanges to include an annual pharmacist-provided comprehensive medication review as a quality improvement strategy.
  • OPM should include PBM transparency requirements in any forthcoming proposed requirements that are consistent with proposed HHS regulations on health insurance exchanges.

“These commonsense solutions will allow independent community pharmacists to play a greater role in reducing costs and improving outcomes through the proper use of generic drugs and effective face-to-face counseling to ensure that patients take their medication as directed by their doctors,” Hoey said.