ASCO's PBM Statement Shapes Medicare Advantage & Part D Proposal

Statement By American Society of Clinical Oncology (ASCO) President Howard A. “Skip” Burris III, MD, FACP, FASCO
February 6, 2020

“The American Society of Clinical Oncology (ASCO) applauds the Centers for Medicare & Medicaid Services (CMS) for reflecting recommendations in the Society’s position statement on pharmacy benefit managers (PBMs) in the agency’s 2021 and 2022 Medicare Advantage and Part D proposed rule.  

“ASCO’s statement, released in August 2018, urged CMS to instruct contractors and PBMs to stop basing performance assessment and related direct and indirect remuneration (DIR) fees on current Star performance ratings. A separate DIR fee, known as a “claw back,” occurs when PBMs retroactively collect fees based on physicians’ and pharmacists’ performance on metrics that currently are not pertinent to oncology. ASCO called for the discontinuation of claw backs and for CMS to use measures and standards that are more appropriate to the specialty when evaluating the performance of dispensing physicians and practice-based pharmacies. 

“CMS’ contract year 2021 and 2022 Part D proposal was clearly shaped by ASCO’s position statement in that the agency is seeking comment on PBM performance measures, including feedback on Star performance ratings and ways to incentivize the use of standard measures sets.”

“Given the enormous leverage that PBMs have over the delivery of cancer care, we thank CMS for the provisions in its proposal to improve PBM transparency. We also appreciate CMS for working with us to improve cancer care for all Americans, and we look forward to continuing to work with the agency as the U.S. cancer care delivery system continues to evolve.”