Competition is the key to lower drug costs, the Pharmaceutical Care Management Association (PCMA) said in a letter to lawmakers in defense of pharmacy benefit managers.
“As Congress looks into drug pricing, we know that more needs to be done, and we believe the key to reducing prescription drug costs is increasing and encouraging competition.” said PCMA President and CEO J.C. Scott.
PCMA also called on Congress to address Medicare Part D’s protected classes — classes of drugs where all or most must be covered. The Centers for Medicare & Medicaid Services already applies formulary coverage checks to assure proper coverage, and a CMS plan that would lessen the effect of protected classes rather than eliminating them could save $2 billion over a decade, PCMA said.
The group called for an update to the “outmoded” Part D requirement that plans cover two drugs per class, claiming that the requirement has created an incentive for drugmakers to drive up Part D costs through “ever more granular classes and reduced competition.” Instead, plans should be required to ensure access to treatment based on conditions or disease states, which would reduce costs without affecting access, the group said.
PCMA also called for the use of management tools for Part D drugs, including value-based formularies, manufacturer negotiation and prior authorization, noting they have helped lower costs for outpatient prescription drug plans and could improve affordability for Part B drugs.