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Pharmacy orgs commend Senate Finance Committee for bipartisan efforts to deliver comprehensive PBM reform

The Committee advanced a comprehensive PBM reform package, the Modernizing and Ensuring PBM Accountability Act, on a bipartisan vote of 26-1.

Pharmacy organizations, including the National Association of Chain Drug Stores, the National Community Pharmacists Association and t​​he Senior Care Pharmacy Coalition are applauding the U.S. Senate Committee on Finance for its bipartisan efforts to crack down on pharmacy benefit managers.

On Wednesday, the Committee held a legislative markup on a set of PBM proposals that it says “will modernize federal prescription drug programs and put a stop to practices by pharmacy benefit managers that are driving up drug costs for patients and taxpayers.” The Committee advanced the comprehensive PBM reform package, the Modernizing and Ensuring PBM Accountability Act, on a bipartisan vote of 26-1.

NACDS president and CEO Steve Anderson said, “The Senate Finance Committee on Wednesday demonstrated a bipartisan and extraordinary commitment to patients and to the pharmacies that serve them. NACDS has emphasized that real PBM reform must include Medicare and Medicaid.

“Two billsS. 1038 and S. 2052are vital for real PBM reform, and for addressing ‘pharmaceutical benefit manipulation’ that harms the most vulnerable in the Medicaid and Medicare programs.

“The Senate Finance Committee’s work to date includes many vital aspects of these two bills, and NACDS encourages the Committee to keep building on its highly appreciated work as the Congressional Budget Office provides more of the needed scoring.”

NACDS said it looks forward to continuing to work with leaders in the U.S. Congress "to stop the manipulation by PBM go-betweens that increases patients’ medication costs, limits patients’ choice of pharmacies, restricts access to medicines that are right for them and jeopardizes the pharmacies and pharmacy teams on whom patients rely."

[Read more: NACDS President and CEO Steve Anderson Talks About the State of Retail Pharmacy and 2023 Annual]

Specifically, NACDS looks forward to working on a bipartisan basis throughout the U.S. Congress to implement NACDS’ Principles of PBM Reform. NACDS’ Principles of PBM reform include: stopping explosive retroactive fees; stopping below-cost reimbursement; stopping the gaming of performance measures; stopping ‘specialty definitions’ from steering patients from their pharmacy; stopping mandatory mail-order; stopping limited networks; stopping overwhelming audits; and stopping the undercutting of PBM reform laws.

In advance of the markup, NACDS released a video message reminding the U.S. Congress that true and comprehensive PBM reform must include Medicare and Medicaid.

[Read more: NACDS, Johns Hopkins report: Pharmacies play a vital role in achieving health equity]

The National Community Pharmacists Association also lauded the Senate Finance Committee’s actions. “PBM-insurers have gotten away with their anticompetitive, damaging tactics for too long. Independent pharmacies and the patients they serve need the transparency and relief that the reforms in this package will help provide,” said Anne Cassity, senior vice president of government affairs at NCPA.

Cassity continued, “The Senate Finance Committee has been leading the way in Congress when it comes to examining PBM-insurers, having first held a hearing on this issue back in 2019. In the time since, Chairman Wyden, Ranking Member Crapo and their colleagues and staff have worked hard to understand the issues at hand and develop a package to address them. We’re grateful for the committee’s tireless efforts and are eager partners in seeing that comprehensive PBM reforms move through the process and are signed into law.”

The Senior Care Pharmacy Coalition, the leading national voice for the long-term care pharmacy community, also applauded the Senate Finance Committee for its strong, bipartisan passage of the Modernizing and Ensuring PBM Accountability Act.

The package includes several priority reforms that the LTC pharmacy community has advocated for to increase transparency into PBM business practices while promoting better access to care and lowering costs for the millions of patients they serve every day across the country.

Several SCPC priorities specific to LTC pharmacies are included in the package along with broader reforms relevant to all pharmacies. Among the key elements of the bill are:

  • Medicare Part D provisions requiring MedPAC to report publicly regarding the information PBMs disclose, including payment differentials between pharmacies affiliated with PBMs and unaffiliated pharmacies;
  • Medicare Part D provisions requiring CMS to develop standardized quality measures by pharmacy type, including specific LTC pharmacy metrics, which all Part D Plans would have to use to evaluate pharmacy quality and adjust payments;
  • Medicare Part D provisions requiring claims-level transparency and establishing a payment floor to cover based on pharmacy costs to acquire and dispense a covered drug to a plan enrollee;
  • Medicaid provisions that would require Medicaid managed care plans to reimburse pharmacies based on average acquisition costs and the Medicaid fee-for-service dispensing fee; and
  • Perhaps most importantly for helping to address the cost of prescriptions, the bill would delink PBM compensation from the cost of medications. This would prevent PBMs from pocketing and profiting from ever-increasing list prices and rebates and require them to disclose why they classify certain medications as specialty drugs to prevent them from steering patients to PBM-affiliated specialty pharmacies.

“For too many years, PBMs have been allowed to force their heavy-handed, profit-driven tactics on patients and the pharmacies that serve them. Fortunately, our leaders in Congress are taking important steps to put patient health and access ahead of PBMs’ bottom lines,” said Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition. “On behalf of the long-term care pharmacy community, I commend Chairman Wyden, Ranking Member Crapo, and members of the Senate Finance Committee for their efforts to increase transparency and finally rein in the anti-competitive and unfair business practices of PBMs. Long-term care pharmacies across the U.S. stand behind them and are eager to see this important legislation passed in 2023.”

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