NCPA urges DOGE to investigate PBMs 

ALEXANDRIA, Va. – The National Community Pharmacists Association, in a new letter to the U.S. Department of Health and Human Services, is urging DOGE to focus on pharmacy benefit managers as a major source of waste, fraud and abuse. 

“The increasing dominance of PBMs poses a significant threat to consumers’ convenient access to prescription medications and pharmacy services, while at the same time charging taxpayers excessively and draining limited health care resources in public health programs like Medicare Part D, Medicaid, Tricare and the Federal Employees Health Benefit Plan (FEHBP),” said NCPA CEO B. Douglas Hoey in a letter to Rachel Riley, senior adviser for HHS. 

The letter comes as Congress is considering whether to include PBM reforms in differing spending bills that have passed both the House of Representatives and the Senate and must now be reconciled. 

Hoey said DOGE should work with CMS to eliminate or significantly tighten up the Medicare Drug Price Negotiation Program. 

“We are concerned that pharmacies will have to float the program to the tune of roughly $11,000 per independent pharmacy per week; that pharmacies will not be paid fairly by PBMs; and that manufacturer refund payments to pharmacies will be delayed,” he said. “A recent study found that pharmacies could forfeit an average of $43,000 in annual revenue due to underpayments — roughly equivalent to a pharmacy technician’s yearly salary.” 

Hoey cited reports by the Federal Trade Commission and the House Oversight Committee exposing numerous examples of anticompetitive practices that lead to higher drug costs, fewer options for patients and less competition in the retail pharmacy sector. He also pointed out that President Trump on several occasions called out PBMs as bad actors and that curbing their influence would be part of his plan for lower drug costs. 

Click here to read the full letter. 

• Related: FTC scrutinizes PBM markups.