Medicare advisers review PBM data in Part D

The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises the U.S. Congress on issues affecting the Medicare program began to delve into its treasure trove of information from pharmacy benefit managers (PBMs) during a public meeting last week with initial findings to be published in its June report to Congress.

A 2021 law granted MedPAC access to direct and indirect renumeration (DIR) data collected by CMS to administer Medicare’s prescription drug program under Part D.

A few notable findings from MedPAC’s meeting were:

• Total DIR grew from 11% of gross Part D spending in 2010 to about 27% in 2020.
• Pharmacy DIR’s share of total DIR grew from <0.1% in 2010 to nearly 18% in 2020.
• The largest Part D plan sponsors received proportionately more DIR.
• In 2020, a disproportionate share of manufacturer rebates was for drugs with prices below $700 (79% of rebates).
• Net of rebates between 2010 and 2020:
  • Prices for brand-name drugs more than doubled in Part D.
  • Spending for high-priced drugs grew rapidly.

There was no discussion or mention of the negotiated rate at the pharmacy counter and how it has increased and been offset with higher pharmacy DIR fees. MedPAC’s recommendations and reports are often used by Congress as the basis for federal legislation. APhA is compiling a list of issues MedPAC should examine as well as the PBM and DIR data that should be publicly released for additional third-party analysis.