The Community Oncology Alliance (COA), an organization that advocates for community oncology practices, commissioned this white paper. It highlights a fascinating case study in the conflicts between payer-owned specialty pharmacies and physician dispensing.

CVS Caremark, one of the largest PBMs and the largest specialty pharmacy, now interprets federal regulations to mean that physician offices not otherwise licensed as a pharmacy are out-of-network in Medicare Part D networks. CVS Caremark therefore notified dispensing physicians that under the PBM’s interpretation of Part D regulations, practices without a pharmacy license would be excluded beginning January 1, 2017.

The white paper attacks CVS Caremark’s interpretation of CMS regulations as “wrong and unsupported.” (Fair warning: The white paper is quite wordy and would have benefited from some tight editing.) Meanwhile, CVS Caremark contends that it checked with CMS before going ahead with this change, per this OncLive article. More to come!

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