PBM Reform and Supportive Care Needs: Nicolas Ferreyros

This year's pharmacy benefit manager (PBM) reform was a meaningful first step but did not go far enough, and community oncology also needs more resources to address social needs and supportive services, according to Nicolas Ferreyros, managing director of policy, advocacy, and communications at the Community Oncology Alliance (COA).

In an interview with The American Journal of Managed Care^®, Ferreyros discussed the next steps for PBM reform, the resources needed to address social determinants of health, and the outlook for community oncology.

Why PBM Reform Needs to Go Further

According to Ferreyros, COA spent more than a decade advocating for PBM reform before Congress acted this year. Ferreyros called the change meaningful and said COA is glad Congress took the step but stressed that much more examination is needed.

A central concern is the vertical integration of PBMs and insurers, which Ferreyros described as big, integrated entities that often own each other. Ferreyros said policy makers need to look closely at how they deal with one another, including their relationships and contracting terms. Federal agencies such as the Federal Trade Commission and CMS are also examining PBM practices and trying to hold them accountable, Ferreyros noted.

"What we really need is to much more aggressively move on PBM reform [and] introduce much better transparency," Ferreyros said.

The ultimate goal, according to Ferreyros, would be to address rebates and the rebate system, which Ferreyros said creates significant dysfunction in the marketplace. Ferreyros said that is hopefully on the horizon.

What Social Determinants of Health Efforts Require

On social determinants of health and health equity, Ferreyros said the main challenge is not identifying needs but receiving the resources to address them. A physician whose patient says they are struggling to pay rent or afford food needs the means to help, and Ferreyros said that responsibility falls on the entire health care system and society.

"A patient going through cancer care should not have to think of a roof over their heads or where their next meal is going to be coming from," Ferreyros said.

Support staff are part of the equation as well. Ferreyros said practices are not adequately covered for the social workers and counselors who help patients navigate these issues, and they face headwinds in continuing to provide that help. Cancer care, in Ferreyros' view, extends well beyond the drug administered in the office. It includes supportive services after treatment, nutrition and counseling during treatment, and social worker assistance, much of which is not funded enough or at all.

Why the Outlook for Community Oncology Is Bright

Looking ahead, Ferreyros said community oncology is on the precipice of a new era of tremendous growth. Ferreyros pointed to a positive and supportive policy environment, particularly around reforming major drivers of consolidation such as 340B and site-neutral payments. There is also growing understanding that the PBM and insurer complex has been driving up prices and making life harder for patients and practice professionals.

Ferreyros expects those trends to continue into next year as the 340B adjustments take effect. "I really am hopeful that the future of community oncology looks bright and that we have a great future ahead of us," Ferreyros said.