The National Organization of Rheumatology Managers (NORM) joined the Alliance for Transparent & Affordable Prescriptions (ATAP) in May 2017 and has been actively involved in the ongoing advocacy efforts of this coalition (see box for complete list of current ATAP members). The goals of ATAP are to educate physicians, patients, legislators, and the general public about pharmacy benefit managers (PBMs) and their role in the prescription drug market, with the aim of bringing awareness to the impact that PBMs have on drug costs and access to treatment, and to ensure patients have access to effective and affordable medication therapies by developing and implementing a comprehensive advocacy plan that seeks to increase transparency and further regulate PBM practices through legislation and public policy at both the state and federal levels.1 This article highlights some of ATAP’s recent successes in attaining these important goals.
ATAP Coalition Members
- Coalition of State Rheumatology Organizations
- American College of Rheumatology
- Global Healthy Living Foundation
- Rheumatology Nurses Society
- National Organization of Rheumatology Managers
- Florida Society of Rheumatology
- Association of Women in Rheumatology
- New York State Rheumatology Society
- California Rheumatology Alliance
- North Carolina Rheumatology Association
- American Psychiatric Association
- Tennessee Rheumatology Association
- American Association of Clinical Urologists
- US Pain Foundation
- Lupus and Allied Diseases Association
- American Bone Health
- Kentuckiana Rheumatology Alliance
- Ohio Association of Rheumatology
- International Foundation for Autoimmune & Autoinflammatory Arthritis
On January 16, 2018, ATAP filed detailed comments with the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s request for information related to the institution of a mandatory pass-through of rebates and discounts in Medicare Part D. CMS cited data indicating that Part D plans are not passing the significant price concessions they receive from pharmaceutical manufacturers on to the patients, and expressed ideas on how to change that. ATAP strongly supports a mandatory pass-through, as it would directly benefit patients by reducing their costs at the pharmacy counter.
On February 23, 2018, the representatives from ATAP spent the day on Capitol Hill, educating legislators on the ways a mandatory pass-through would benefit patients, and how some of the claims in opposition to a pass-through are red herrings. In the majority of these meetings, congressional staffers conveyed that they were also concerned about the current role of PBMs, and that members of Congress were striving to identify strategies that would improve the currently misaligned incentives in the drug supply chain. These delegates are clearly interested in the issue, as evidenced by the recent introduction of bipartisan legislation that would prohibit “gag clauses” in PBM contracts with pharmacies.2
On March 23, 2018, ATAP filed comments related to transparency—or the lack thereof—in the healthcare system in response to a request from a group of 6 bipartisan senators. The coalition expressed that the pharmaceutical supply chain is in particular need of more transparency, and outlined ideas to accomplish this goal.
Meanwhile, state legislators are also jumping into the fray, and ATAP has developed model legislation to assist them. Recently, Arkansas passed a bill that provides the insurance commissioner with broad authority to regulate PBMs,3 while Florida passed a bill requiring licensure of PBMs.4 ATAP has monitored PBM-related legislation and provided input in several states, including Arkansas, Florida, Ohio, New York, and Louisiana.
The attention of policymakers is squarely on PBMs, and is likely to stay there until meaningful changes are made to the current system. ATAP plans to remain actively engaged in its efforts to advance the voices of patients and clinicians in these discussions.
- Alliance for Transparent & Affordable Prescriptions. https://atapadvocates.com/abou0t-atap/. Accessed March 23, 2018.
- The Hill. Senators target ‘gag clauses’ that hide potential savings on prescriptions. http://thehill.com/policy/healthcare/378639-senators-target-gag-clauses-that-hide-potential-savings-on-prescriptions. Accessed March 27, 2018.
- Arkansasmatters.com. Governor Signs Pharmacy Bill, Reveals Plan to Reorganize State Agencies. www.arkansasmatters.com/news/local-news/governor-signs-pharmacy-bill-reveals-plan-to-reorganize-state-agencies/1048575043. Accessed March 23, 2018.
- The Florida Senate. CS/CS/HB 351: Prescription Drug Pricing Transparency. www.flsenate.gov/Session/Bill/2018/00351. Accessed March 23, 2018.