Since the first “back-door” integrations of consumer (cash discount) cards like GoodRx and others into PBM claims adjudications for insured plans, NCPA has advocated both politically and legally for change. Pharmacies who in many cases had never agreed to or signed up to participate in a consumer card program were suddenly finding their insured patient claims subjected not only to their contracted PBM reimbursement rates, but also another “lessor of” rate from a consumer card within the normal PBM claim adjudication. It looks like that is about to change, at least with one large PBM. Read more …
