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The National Community Pharmacists Association wants Elon Musk's Department of Government Efficiency to help it fight the pharmacy benefit managers.
The pharmacist group announced Friday that it had sent a letter encouraging DOGE to search for waste, fraud and abuse at PBMs.
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The PBMs contend that they fight to hold down prescription drug costs for employer health plan sponsors, insurers and other payers, and they argue that pharmacists and drug manufacturers are attacking PBMs mainly because of the PBMs' success at squeezing other drug supply chain players' profit margins.
The NCPA sees things differently.
B. Douglas Hoey, the chief executive officer of the NCPA, writes in the new letter that the big PBMs have too much clout over how the drug market operates.
"They use this influence to increase their outlandish profits at the expense of taxpayers, patients and local, independently run pharmacies," Hoey writes.
In addition to auditing PBMs' interactions with Medicare, DOGE should audit PBMs' efforts to administer pharmacy benefits for the Federal Employees Health Benefits Health Benefit Plan and for Tricare, Hoey adds.
Tricare is the U.S. Defense Department's employee health benefits program.
If DOGE audits how PBMs manage FEHBP and Tricare pharmacy benefits, "you may find the only parties who benefit from contracting with these entities are the insurers and dominant PBMs," Honey writes.
Hoey predicted that a new Medicare drug price negotiation program will destabilize independent pharmacies by costing the pharmacies an average of $11,000 per week and causing delays in payments of drug manufacturer refund payments to the pharmacies.
Hoey addressed the letter to Rachel Riley, the senior advisor overseeing DOGE activities at the U.S. Department of Health and Human Services.
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NCPA is not the first health care policy player to call for DOGE to turn its attention to PBMs.
In January, Sen. Elizabeth Warren, D-Mass., suggested that DOGE should look into the idea of breaking up big health insurers that own PBMs and physician group practices.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
