by Leslie Small
Nearly two weeks after
the Trump administration issued a proposed rule that would effectively overhaul
the prescription drug rebate system, the dust has still not settled in the PBM
sector as firms brace for a seismic shift in how they do business.
The proposed rule would
remove safe-harbor protections under the federal anti-kickback statute for
rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed
care organizations. It would also create two new safe harbors: one for
prescription drug discounts offered directly to patients, and one for fixed-fee
service arrangements between drug manufacturers and PBMs.
If the rule is enacted,
"the entire Part D and Managed Medicaid pharmacy management industry would
have to change," Mike Kolar, senior vice president and general counsel of
Prime Therapeutics, LLC, tells AIS Health. "Prime, and other PBMs, will
need to develop new tools and methods to continue to negotiate price on behalf
of millions of members," he adds.
Kolar adds that Prime is
"concerned about the adverse economic impacts of the proposal," as it
could raise Medicare Part D premiums and government program costs.
Dea Belazi, president and
CEO of specialty-pharmacy-focused PBM AscellaHealth, says the new proposal, if
enacted, "is going to be a revenue hit" for his company,
"because it is dollars that come in that will no longer come in if this
goes through." But it's certainly not going to put the PBM out of
business, he adds.
From RADAR on Drug Benefits
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