ATAP Responds to Federal Innovation Center Request for Information

In a letter submitted to the Centers for Medicare and Medicaid Services (CMS), the Alliance for Transparent and Affordable Prescriptions (ATAP) urged the agency to address the increasingly harmful role of pharmacy benefit managers (PBMs) in the prescription drug delivery system. This letter came in response to a Request for Information soliciting feedback on a “new direction” for the Center for Medicare and Medicaid Innovation (CMMI) to promote patient-centered care and test market-driven reforms that improve quality of care and reduce costs.

In its comments, ATAP recognized CMMI as an important tool in developing innovative solutions to improve patient outcomes while controlling drug costs: “With its authority to test models on small scales, CMMI can play a unique role in returning us to a rational system that puts patients at the center while controlling drug prices. CMMI has the ability to be nimble in testing ideas, so that we can be sure solutions work for patients before any program changes are implemented on a wider scale.”

While acknowledging that CMMI may have limited authority in Part D, ATAP urged CMMI to consider drug pricing models and demonstrations that incorporate the following elements to the extent possible:

1. Return the PBM to its original, purely administrative function.

2. Require the PBM to adhere to Food and Drug Administration (FDA) regulations of what
   constitutes a “generic” versus a “brand” product to avoid purposeful misclassification
   leading to generics being charged as brands.

3. Prohibit the use of gag orders on pharmacists so that a consumer can be told when (s)he
   would be best served by paying cash for the prescription.

4. Require pass-through of rebates and any other prices concessions at the point-of-sale.

ATAP looks forward to continuing to work with CMS and the Innovation Center as they move forward with this new direction and develop models to address the prescription drug market.