During a Senate Judiciary Committee hearing on Tuesday, Sen. Chuck Grassley (R-IA) called for transparency from pharmacy benefit managers.
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00:00with my Iowa constituent. Last year, 29 Iowa pharmacies closed, many of which were in rural
00:07areas and have served their communities for decades. You own a small group of rural pharmacies
00:14and recently had to close some. What legislation would you like to see Congress pass to help rural
00:21pharmacists like yourself and the patients you serve? And since bureaucracy can work faster than
00:29Congress, is there anything that HHS can be doing that would help along this line?
00:36Senator Grassley, I appreciate the question. Before answering your question, I do have a couple
00:41of points. One is I want to be clear that pharmacy deserts occur not only in rural areas but also
00:48urban areas, negatively affecting the care of our most vulnerable patients. The second point is that
00:55community pharmacy is much more than just a place where prescriptions are filled. It's a place where
00:59patients have access to a trusted healthcare partner. It's a place where patients receive
01:04healthcare services ranging from medication management, point-of-care testing, and immunizations
01:10to health promotion and chronic disease management. It's a place where care coordination and medication
01:17management service help patients achieve optimal outcomes. And it's a place where pharmacists and
01:22their staff work closely and collaboratively with physicians, other providers, and community-based
01:28organizations to optimize patient care. To answer the question, as far as the first part of your question
01:35and legislation, I think a good place to start is your bill, S-526, the PBM Transparency Act,
01:42where it bans PBM deceptive and unfair pricing schemes, prohibits PBM clawbacks of payments that have been made to
01:49pharmacies and improves transparency about spread pricing and pharmacy fees.
01:56Next, I'd like to address the fair reimbursement to community pharmacies in Medicare Part D, Senate Bill 5 or S-882,
02:05the Patients Before Middlemen Act, and enhances the PBM Transparency and Accountability to Reduce Prescription Costs for Seniors.
02:14Also ensures all treatments are fair treatment for all pharmacies as it relates to Medicare Part D contracts.
02:22But what's missing is, again, addressing reasonable and relevant Part D reimbursement from CMS to make pharmacies whole.
02:30Lastly, I talked about the services that we provide beyond prescription dispensing. I do think we have to develop some kind of a payment model for those services that we provide beyond prescription dispensing.
02:39I do think we have to develop some kind of a payment model for those services that is having impact not only on patient clinical outcomes, but also on total cost of care.
02:50Your second part of your question is about HHS and what they could do, and is it possible to provide authority for the Secretary of HHS to fix Medicare Part D payments for community pharmacies
03:01to ensure fair and reasonable reimbursement so we can continue to provide care to our senior patients.
03:09Ms. Faust, my PBM Transparency Act will require PBMs to be fully transparent about how much money they make and prove their value.
03:18What kind of transparency does Novita's provide to its clients, and what does real transparency look like?
03:26We provide access to all the data, all the clients' data, and access to what pharmacies are paid and auditability of that as a fiduciary representative for our plan sponsors.
03:49I think your bill does a great job of introducing transparency, and that's really, really needed in this industry.
03:56Okay.
03:57Okay.
03:58Next, I have a question for Professor Sod.
04:04The primary responsibility of a fiduciary is to run a health plan solely in the interest of participants and beneficiaries for the exclusive purpose of providing benefits.
04:16At least five states have imposed fiduciary or duty of care requirements on PBMs should, I think you said this in your statement,
04:26Do you want to expand on what you said in your statement about fiduciary responsibilities?
04:33Sure.
04:34Thank you for the question, Senator Grassley.
04:36I think the price transparency bill that you have proposed complements fiduciary responsibility.
04:44So the idea of price transparency is to figure out if you're getting good value for your money or not, if your PBM is acting in the interest of your members or not.
04:54And what fiduciary responsibility does is it legally obligates the PBM to act in the interest of the members.
05:01So if you find out that the PBM is not acting in the interest of your members, you have some recourse to address that issue.
05:09So I think fiduciary responsibility combined with transparency can really make the markets work better for the American patient.
05:18Okay.
05:19Okay.
05:20Okay.
05:21Okay.