Here is an interesting read... This has been sourced from: https://www.dr-gtopics.com/view/q-a-douglas-hoey-on-pbm-reform-optum-rx-cost-plus-announcement-aap-2025
Not sure how things will change but I am feeling there is a big wave of changes coming our way. We'll see...
Q&A with Douglas Hoey on PBM Reform and Optum Rx's Cost-Plus Announcement
April 14, 2025 | AAP 2025 | Interview by Killian Meara
Context
At the American Associated Pharmacies (AAP) Annual Conference, Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA), spoke about the ongoing delays in PBM (Pharmacy Benefit Manager) reform and responded to Optum Rx's cost-plus reimbursement model announcement.
On PBM Reform
- Despite bipartisan support, Congress has repeatedly delayed PBM reform.
- Hoey remains optimistic, largely because PBM reform would save over $5 billion for taxpayers.
- He emphasizes that patience is wearing thin as independent pharmacies continue to suffer.
- Reform may be pushed through via the reconciliation process, according to congressional leadership.
- Hoey urges pharmacists and patients to continue pressuring lawmakers, stressing that members of Congress have the power to act and should be held accountable.
- Pharmacies are closing, prices are rising, and patients are impacted — Hoey calls for immediate action.
On Optum Rx’s Cost-Plus Reimbursement Model
- Optum Rx aims to stop pharmacy losses on brand dr-gs but proposes reducing margins on generics instead of increasing total reimbursement.
- Hoey likens this to "shuffling the chairs on the Titanic" unless the overall size of the reimbursement pie grows.
- NCPA does not negotiate contracts but PSAOs (Pharmacy Services Administrative Organizations) are in talks with Optum Rx.
- If more funds reach pharmacies, the proposal may have merit — but current details don't show that.
- Hoey remains skeptical, stating "actions will speak louder than words."
- He believes this initiative is partly motivated by brand dr-g abandonment and pressure from companies like Mark Cuban's Cost Plus model.
- CVS and Express Scripts are also attempting cost-plus models, possibly as a strategy to dissuade congressional and FTC scrutiny.
- Hoey reiterates that voluntary market changes are not enough — legislative reform is still urgently needed.
Bottom Line
- Hoey supports innovative reforms but insists that without actual increases in pharmacy reimbursement, proposals like Optum Rx's are just repackaged status quo.
- He calls on Congress to stop delaying and pass PBM reform now, before more damage is done to pharmacies and patient care.