Coalition forms to take on PBM auditing practices

WASHINGTON — A nonprofit pharmacy advocacy group has launched a new project that it said was aimed at ensuring fair audit standards for prescription drug claims paid under the Medicare Part D program and protecting pharmacies and patients from what it called unfair audit and conduct practices by pharmacy benefit managers.

The group, Pharmacy Choice and Access Now also called for federal laws to address what it called inconsistent and nontransparent reimbursement rates and tackle the problem of alleged improper use of patient information. The PBM Reform Coalition will lobby legislators, the public and media on behalf of the issue. The coalition includes PCAN, the National Association of Chain Drug Stores, the National Community Pharmacists Association, H-E-B, Walgreens, PharMerica, Omnicare and GeriMed. As part of its launch, the coalition expressed support for Senate Bill 867, the Medicare Prescription Drug Program Integrity and Transparency Act, which would mandate PBM audit standards, ensure transparency of payment methodology to pharmacies and require that recoupment of money through audits is returned to Medicare.

"Without sufficient regulation or oversight, some PBMs have been largely playing by their own rules, engaging in questionable business practices that are hurting taxpayers as well as patients and their pharmacies, and it's time for this to stop" coalition spokesman and Texas pharmacist Dennis Wiesner said. "We look forward to working with policymakers and others to advance appropriate reform measures that establish standards that protect all parties — measures that keep healthcare costs down, preserve patient choice and allow pharmacies to remain focused on their number-one priority — providing accessible quality health care to their patients."