There really hasn’t been a lot of good news in the specialty pharmacy industry this year. Demand has been down due to the virus. Increasing DIR fees continue to bleed off profits. Virtually no FDA 2020 approvals will come to market in open access. But, the press release below from the National Association of Specialty Pharmacy (NASP) unwraps a gift under the 2020 specialty pharmacy Christmas tree.
Recently, the US Supreme Court issued an 8-0 decision confirming a state’s right to regulate the level of reimbursement by PBMs to specialty pharmacies. It has the effect of ensuring that specialty pharmacies should not be reimbursed at a rate lower than their actual acquisition cost. In short, pharmacies will not have to suffer an automatic loss on many prescriptions where the PBM arbitrarily sets reimbursement in RED levels. That is a BIG deal and the best gift that the industry could hope for at the close to a very challenging year.
Specialty Pharmacy Applauds Supreme Court Decision to Allow States to Regulate PBM Practices
WASHINGTON, Dec. 11, 2020 /PRNewswire/ — The National Association of Specialty Pharmacy (NASP) applauds the 8-0 decision by the Supreme Court to restore Arkansas’ right to govern the amount that Pharmacy Benefit Managers (PBMs) reimburse pharmacies, in Rutledge v. the Pharmaceutical Care Management Association (PCMA). This decision will give states more flexibility to oversee PBM reimbursement practices to ensure patient access and affordability and protect market competition.
Since 2012, NASP members have reported a dramatic decrease in prescription reimbursement and an increase in claw-back fees such as Direct and Indirect Remuneration (DIR) by many PBMs.
“NASP is pleased with the Supreme Court’s unanimous ruling and believes this decision will protect states’ rights to oversee and control abusive practices. Reimbursements from PBMs that are below a specialty pharmacy’s cost threaten patient care and medication access. Specialty pharmacies provide critical care and services for patients living with cancer, rheumatoid arthritis, multiple sclerosis, cystic fibrosis, HIV/AIDS, and other chronic and complex diseases. Today’s decision is a key step in providing the oversight needed to ensure patients have access to the quality care that specialty pharmacies provide,” said Sheila M. Arquette, RPh, NASP President & CEO.”
Contact: Sheila M. Arquette, RPh, President & CEO, (703) 842-0122
The National Association of Specialty Pharmacy (NASP) is the only national association representing all stakeholders in the specialty pharmacy industry. NASP members include the nation’s leading specialty pharmacies, pharmaceutical and biotechnology manufacturers, group purchasing organizations, patient advocacy groups, integrated delivery systems and health plans, technology and data management vendors, wholesalers/distributors, healthcare providers, and practicing pharmacists. With over 130 corporate members and approximately 1,800 individual members, NASP is the unified voice of specialty pharmacy in the United States.
SOURCE National Association of Specialty Pharmacy