TOPICS
TOPICS
Key players debate how to lower prescription drug costs for feds
Key players in the drug pricing debate discussed several options for reducing costs -- ranging from statutory pricing to "carving out" a single prescription drug plan for those enrolled in the Federal Employees Health Benefits Program -- during a private meeting Tuesday on Capitol Hill.
According to attendees of the meeting, which was closed to the public, much of the discussion focused on pharmaceutical benefit managers, who act as a go-between for FEHBP carriers and enrollees when it comes to prescription drugs and services. Many critics of PBMs have argued that higher prescription drug costs for FEHBP enrollees -- as much as 45 percent higher than other federal health care programs that purchase drugs -- were due to a lack of transparency and accountability for PBMs.
The meeting was held by the House Oversight and Government Reform Subcommittee on the Federal Workforce, Postal Service and the District of Columbia. Participants included PBMs Medco Health Solutions and Argus Health Systems; health insurance carriers Blue Cross/Blue Shield Association, Humana Health Plan Inc., and Aetna Inc.; and federal employee groups the American Federation of Government Employees and National Treasury Employees Union.
No consensus was reached, participants said after the meeting, but the discussion focused on four proposals to reduce prescription drug costs for federal employees: using a statutory pricing system similar to what other government entities such as the Veterans Affairs Department use to buy drugs; designating pharmaceutical benefit managersas federal subcontractors to increase government oversight; enabling the Office of Personnel Management to negotiate a single prescription drug benefit for all FEHBP enrollees; and strengthening OPM's power to enforce transparency and prohibit over-pricing.
One option -- called a "carve-out" -- would allow OPM to negotiate a single drug benefit to replace the myriad drug benefits currently available through individual FEHBP plans. Daniel Adcock, legislative director for the National Active and Retired Federal Employees Association, said such a proposal -- which would take advantage of the "economy of scale" with the millions of FEHBP enrollees -- had been a NARFE proposal. Adcock said his organization has supported all the proposals under discussion.
The subcommittee's chairman, Rep. Stephen Lynch, D-Mass., previously advocated designating PBMs as federal subcontractors, to ensure that they are subject to the Federal Acquisition Regulation. Doing so, he has argued, would ensure more transparency of overhead administrative costs and of the financial relationship between PBMs and the health care carriers that contract with them.
Other organizations supported the idea of strengthening OPM regulations to deal with the issue immediately, without waiting for a legislative change.
NTEU has strongly supported statutory pricing, which would allow the government to purchase drugs based on formulas set in the law. Federal departments such as Defense and VA already use the Federal Supply Schedule, a similar system, to buy prescription drugs, while the Medicare program employs a different formula to determine reimbursement rates. According to NTEU, statutory pricing could result in a 50 percent savings to the government.
"This would be a major step forward in helping make FEHBP coverage more affordable for federal employees, retirees and their families, and help make the federal government the employer of choice for the kinds of high-quality workers agencies need now and will need in greater numbers in the future," NTEU President Colleen M. Kelley said in a statement.
The subcommittee plans to release a report on Tuesday's discussion.
COMMENTS
- More info on the price gouging on prescriptions.....I might add that if I fill my Snythroid through the mail order program offered by BCBS, it costs $65.00 for a 90 day supply because it is label. If I fill it at King Soopers Grocery Store here in Colorado, using the brand label Synthroid, it is $15.47 for the 90 day supply. (I have to take label because of the sensitivy of my thyroid...the generic brand doesn't work for me...causes my thyroid to go up an down.) Anyway...I called and asked the mail order folks why there's is $65.00 for the 90 day supply, and the lady on the end of the phone said, because that is what your insurance company contracted with us for brand. I asked her why would I fill it for $65.00 when I could get it for $15.47 at my local pharmacy for a 90 day supply? She became irritated with me and said because thats what they contracted for. People are getting taken with these prescriptions even with insurance coverage. The costs shouldn't change from mail order to local pharmacy costs. Someone's not monitoring the system. Another prescription I'm on costs me $95.00 (it's actually $92.44) per month with my insurance coverage. It says on my prescription label that my insurance saved me $482.65. Figure that. I still had to pay $95.00 with insurance. How can the American people continue to pay these costs? Unfortuantely, I need these meds....I didn't ask to want to be on them, my body doesn't function without them. I like the rest of the American public are getting hosed on our prescription benefits. Deb Posted October 23, 2009 10:05 AM
- More info on the price gouging on prescriptions.....I might add that if I fill my Snythroid through the mail order program offered by BCBS, it costs $65.00 for a 90 day supply because it is label. If I fill it at King Soopers Grocery Store here in Colorado, using the brand label Synthroid, it is $15.47 for the 90 day supply. (I have to take label because of the sensitivy of my thyroid...the generic brand doesn't work for me...causes my thyroid to go up an down.) Anyway...I called and asked the mail order folks why there's is $65.00 for the 90 day supply, and the lady on the end of the phone said, because that is what your insurance company contracted with us for brand. I asked her why would I fill it for $65.00 when I could get it for $15.47 at my local pharmacy for a 90 day supply? She became irritated with me and said because thats what they contracted for. People are getting taken with these prescriptions even with insurance coverage. The costs shouldn't change from mail order to local pharmacy costs. Someone's not monitoring the system. Another prescription I'm on costs me $95.00 (it's actually $92.44) per month with my insurance coverage. It says on my prescription label that my insurance saved me $482.65. Figure that. I still had to pay $95.00 with insurance. How can the American people continue to pay these costs? Unfortuantely, I need these meds....I didn't ask to want to be on them, my body doesn't function without them. I like the rest of the American public are getting hosed on our prescription benefits. Deb Posted October 23, 2009 11:52 AM
- Import them from countries that we require our drbrand name formulary manufactures to provide low cost formulay even for drugs that still are supposted to be protected from copy. It's a shell game the US taxpayer is still going to gaurantee the profits by allowing folks in other programs access to brand name formulary (so R&D costs are covered) it all just comes out of a different bucket. This way a couple of hundred US jobs can go to India or China where we can be sure the quality control is better then the US government provides due to continuing resolutions and an emphasis on contract work. WEB Posted October 10, 2009 10:08 PM
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