{"id":12203,"date":"2024-07-01T07:50:42","date_gmt":"2024-07-01T07:50:42","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=12203"},"modified":"2024-07-01T07:50:42","modified_gmt":"2024-07-01T07:50:42","slug":"wyden-cms-action-express-scripts","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/wyden-cms-action-express-scripts\/","title":{"rendered":"Wyden Demands CMS Action Against Express Scripts&#8217; Tactics"},"content":{"rendered":"\r\n<div id=\"rank-math-toc\" class=\"wp-block-rank-math-toc-block has-electric-grass-gradient-background has-background\"><nav>\r\n<ul>\r\n<li><a href=\"#introduction\">Introduction<\/a><\/li>\r\n<li><a href=\"#background-on-pbm-practices\">Background on PBM Practices<\/a><\/li>\r\n<li><a href=\"#ron-wydens-stand\">Ron Wyden&#8217;s Stand<\/a><\/li>\r\n<li><a href=\"#impact-on-independent-pharmacies\">Impact on Independent Pharmacies<\/a><\/li>\r\n<li><a href=\"#express-scripts-and-cvs-caremark-key-players\">Express Scripts and CVS Caremark: Key Players<\/a><\/li>\r\n<li><a href=\"#the-call-to-cms-for-intervention\">The Call to CMS for Intervention<\/a><\/li>\r\n<li><a href=\"#conclusion\">Conclusion<\/a><\/li>\r\n<li><a href=\"#fa-qs\">FAQs<\/a>\r\n<ul>\r\n<li><a href=\"#q-1-what-are-pb-ms\">Q1: What are PBMs?<\/a><\/li>\r\n<li><a href=\"#q-2-why-is-ron-wyden-concerned-about-pbm-practices\">Q2: Why is Ron Wyden concerned about PBM practices?<\/a><\/li>\r\n<li><a href=\"#q-3-what-is-the-any-willing-pharmacy-requirement\">Q3: What is the &#8220;Any Willing Pharmacy&#8221; requirement?<\/a><\/li>\r\n<li><a href=\"#q-4-how-have-express-scripts-and-cvs-caremark-been-implicated\">Q4: How have Express Scripts and CVS Caremark been implicated?<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/nav><\/div>\r\n\r\n\r\n\r\n<h3 id=\"introduction\" class=\"wp-block-heading\">Introduction<\/h3>\r\n\r\n\r\n\r\n<p>The intricate dynamics of the pharmaceutical industry often leave small players struggling against giants. This reality has been thrust into the spotlight by Senator Ron Wyden, who has called for urgent intervention by the Centers for Medicare &amp; Medicaid Services (CMS). Wyden&#8217;s primary concern is the <a href=\"https:\/\/ncpa.org\/newsroom\/qam\/2024\/06\/27\/wyden-pushes-cms-greater-oversight-pbms-adhering-dir-rule\" target=\"_blank\" rel=\"noopener\">enforcement of Medicare Part D program<\/a> requirements for pharmacy benefit managers (PBMs), whose practices are reportedly crippling the financial health of smaller pharmacies.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"background-on-pbm-practices\" class=\"wp-block-heading\">Background on PBM Practices<\/h3>\r\n\r\n\r\n\r\n<p>Pharmacy Benefit Managers (PBMs) play a crucial role in managing prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. However, their role has increasingly come under scrutiny due to practices that appear to prioritize profits over fair access to medications and reasonable pharmacy reimbursements.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"ron-wydens-stand\" class=\"wp-block-heading\">Ron Wyden&#8217;s Stand<\/h3>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.wyden.senate.gov\/meet-ron\" target=\"_blank\" rel=\"noopener\">Senate Finance Committee Chair Ron Wyden, D-Oregon<\/a>, has been vocal about the need for CMS to take a stronger stance against PBMs. In a recent letter to the agency, Wyden highlighted alarming reports that PBM contracting practices are financially straining pharmacies, leading to closures and reduced access to necessary medications.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"impact-on-independent-pharmacies\" class=\"wp-block-heading\">Impact on Independent Pharmacies<\/h3>\r\n\r\n\r\n\r\n<p>The financial strain on independent pharmacies is significant. More than 300 independent pharmacies closed in the last year alone, with 35 closures in Oregon, Wyden&#8217;s home state. These closures are not just numbers; they represent a loss of essential community resources. Wyden argues that PBMs are enforcing unfair contracting terms and low reimbursement rates, making it unsustainable for many pharmacies to operate.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"express-scripts-and-cvs-caremark-key-players\" class=\"wp-block-heading\">Express Scripts and CVS Caremark: Key Players<\/h3>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.express-scripts.com\/art\/open_enrollment\/TargetBenOverview.pdf\" target=\"_blank\" rel=\"noopener\">Express Scripts<\/a> and <a href=\"https:\/\/www.caremark.com\/portal\/asset\/LMC_FAQ.pdf\" target=\"_blank\" rel=\"noopener\">CVS Caremark<\/a> are at the forefront of these troubling practices. According to a February 2024 survey by the National Community Pharmacists Association, these two PBMs are primarily responsible for the financial difficulties faced by many pharmacies. Wyden expressed particular concern about Express Scripts, whose Part D market share has grown significantly, especially among dual-eligible Part D enrollees. This growth has seemingly emboldened Express Scripts to expand predatory pricing tactics that severely cut pharmacy revenues.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"the-call-to-cms-for-intervention\" class=\"wp-block-heading\">The Call to CMS for Intervention<\/h3>\r\n\r\n\r\n\r\n<p>Wyden&#8217;s call to action involves several key points:<\/p>\r\n\r\n\r\n\r\n<p>1. Enforce the &#8220;Any Willing Pharmacy&#8221; Requirement: This mandate requires PBMs to reimburse pharmacies at least the cost of acquiring and dispensing prescription drugs. Wyden argues that strict enforcement of this rule is essential to ensure pharmacies can sustain their operations.<\/p>\r\n\r\n\r\n\r\n<p>2. Apply Pharmacy Price Concessions at the Point of Sale: Wyden insists that price concessions should be reflected at the point of sale, as indicated by existing regulations. This change would help to ensure transparency and fairness in pricing.<\/p>\r\n\r\n\r\n\r\n<p>3. Monitor Complaints and Enforcement: Wyden has requested detailed information on whether complaints about PBM policies have increased in the past 18 months, signaling a need for better monitoring and enforcement of existing rules.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"conclusion\" class=\"wp-block-heading\">Conclusion<\/h3>\r\n\r\n\r\n\r\n<p>The pricing tactics of PBMs, particularly those of Express Scripts and CVS Caremark, have sparked significant concern among lawmakers and industry stakeholders. Senator Ron Wyden&#8217;s push for CMS intervention is a critical step toward addressing these issues. Ensuring fair practices and adequate reimbursement for pharmacies is essential for maintaining a robust and accessible healthcare system.<\/p>\r\n\r\n\r\n\r\n<p><span class=\"ui-provider a b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">Discover the latest <a class=\"fui-Link ___1rxvrpe f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. 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Join our community today!<\/span><\/p>\r\n\r\n\r\n\r\n<h3 id=\"fa-qs\" class=\"wp-block-heading\">FAQs<\/h3>\r\n\r\n\r\n\r\n<h4 id=\"q-1-what-are-pb-ms\" class=\"wp-block-heading\">Q1: What are PBMs?<\/h4>\r\n\r\n\r\n\r\n<p>A1: Pharmacy Benefit Managers (PBMs) are third-party administrators of prescription drug programs for health plans, Medicare Part D drug plans, large employers, and other payers.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"q-2-why-is-ron-wyden-concerned-about-pbm-practices\" class=\"wp-block-heading\">Q2: Why is Ron Wyden concerned about PBM practices?<\/h4>\r\n\r\n\r\n\r\n<p>A2: Wyden is concerned that PBMs are enforcing unfair contracting terms and low reimbursement rates, leading to financial strain and closures of independent pharmacies.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"q-3-what-is-the-any-willing-pharmacy-requirement\" class=\"wp-block-heading\">Q3: What is the &#8220;Any Willing Pharmacy&#8221; requirement?<\/h4>\r\n\r\n\r\n\r\n<p>A3: This requirement mandates that PBMs reimburse pharmacies at least the cost of acquiring and dispensing prescription drugs, ensuring fair compensation for pharmacies.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"q-4-how-have-express-scripts-and-cvs-caremark-been-implicated\" class=\"wp-block-heading\">Q4: How have Express Scripts and CVS Caremark been implicated?<\/h4>\r\n\r\n\r\n\r\n<p>A4: These two PBMs have been identified as major contributors to the financial difficulties faced by pharmacies, with reports of predatory pricing tactics and unfair reimbursement practices.<\/p>\r\n\r\n\r\n","protected":false},"excerpt":{"rendered":"<p>Introduction The intricate dynamics of the pharmaceutical industry often leave small players struggling against giants. This reality has been thrust&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/wyden-cms-action-express-scripts\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":12204,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[391],"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12203"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=12203"}],"version-history":[{"count":5,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12203\/revisions"}],"predecessor-version":[{"id":12231,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12203\/revisions\/12231"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/12204"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=12203"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=12203"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=12203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}