Pharma middlemen propose regulatory changes to avoid Trump administration rules: Report

Pharmacy middlemen are working on a proposal to change some of their business practices in order to avoid new regulations from the Trump administration, Bloomberg News reported on Wednesday, citing people familiar with the discussions.

The Pharmaceutical Care Management Association (PCMA), a key lobbying group for pharmacy middlemen, is drafting recommendations to present to the Centers for Medicare and Medicaid Services, Bloomberg News reported, citing a reviewed document.

Proposals under discussion include measures such as ensuring patients do not pay more than the cash price charged to uninsured customers, increasing the use of lower-cost alternatives to expensive biologic drugs and increasing reimbursement rates for rural and independent pharmacies.


The middlemen - pharmacy benefit managers - are companies that handle prescription drug benefits for health insurance companies, large employers, and Medicare prescription drug plans - a group often referred to as payers.

The three biggest pharmacy benefit managers in the space are UnitedHealth Group's OptumRx, CVS Health's CVS Caremark and Cigna's Express Scripts.

Pharmacy benefit managers are under growing scrutiny as the Trump administration calls for tighter regulations on how the industry negotiates discounts on prescription medications with drugmakers on behalf of health plans and employers.

CVS Health declined to confirm the report but said it stands "ready and willing to work with the Administration and Congress to support efforts that make prescription drug coverage more affordable and easier to use".

UnitedHealth Group and Cigna did not immediately respond to Reuters' requests for comment.

The PCMA document also suggested that a high-profile announcement of the initiative could help generate favorable media coverage for the industry, according to the Bloomberg News report.