NACDS - National Association of Chain Drug Stores Inc.

07/22/2024 | Press release | Distributed by Public on 07/22/2024 14:48

Amid House Oversight Hearing, Pharmacy Organizations Issue United Call for Action on ‘Must-Pass’ PBM Reform Legislation

A coalition of organizations representing pharmacies and pharmacists across all practice settings released a statementtoday ahead of a Tuesday, July 23 U.S. House Committee on Oversight and Accountability hearing titled, "The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability."

The multi-association coalition, made up of the following groups - the National Association of Chain Drug Stores, the National Community Pharmacists Association, the American Pharmacists Association, the National Association of Specialty Pharmacy, FMI - The Food Industry Association, the National Grocers Association, the National Alliance of State Pharmacy Associations, and Independent Pharmacy Cooperative - stated the following in their letter:

We write - firmly united - as pharmacies and pharmacists across all practice settings.

We extend our deepestgratitude and strongestencouragementfor your continued bipartisan scrutinyofthe practicesofsome market-dominantpharmacybenefitmanager (PBM) middlemen thatinflate Americans' prescription drugcosts,force pharmacyclosures,and block accessto Americans'pharmaciesofchoice.

Speaking with one voice,we also urge the U.S.Congressto send to PresidentBiden'sdeskthis year the must-passPBMreformsin Medicare,Medicaid,and the commercialmarketsthatat long lastwould confrontthese harmfulpractices,and thathaveadvancedon abipartisanbasis in the U.S.House ofRepresentativesand the U.S.Senate.

Throughoutthe Committee on Oversightand Accountability'sinvestigation,our organizations and individualmembershave provided examplesand insightsaboutconcerning PBMpractices and their harms.Pharmaciesand pharmacistshaveexperiencedand warned aboutthese tacticsfor upwardsof15 years.Unabated andunchecked byfederalaction,these tacticsand theirdevastating effectshave escalated consistentlyand severely - and theyhave reached even new extremes in 2024.

As is now widely known,every day thatpasses withoutreformmeans more dollars flowing to PBMs instead ofreducing Americans' prescription drug costs and safeguarding access to trustedand convenientpharmacies.

Thankfully,recognition ofsome dominantPBMs' devastating practicestodayisprevalentamong Republicansand Democrats,conservativesand progressives,federal and state governments, employers,unions,patientgroups,providers,rural and urbanhealth advocates,and diverse media outlets.

It is past time for action.

Throughoutthe 118th Congress,wehave articulatedclearlypharmacies'legislative prioritiesthat arenecessaryto confrontthe harmsthatare ravaging Americansand their pharmacies.The following aspectsofreform are absolutelynecessaryto ensure thata reform package iseffective and thatitcanbe supportedbypharmacies:

  • Medicaid managed carepharmacypaymentreform and a banon spreadpricingby requiring 100%pass-through to the pharmacyoftheingredientcostand ofthe professional dispensing fee,which couldallow the federal governmentand statesto save billionsof dollars.
    • Ensuring fair and adequate Medicaid managed care pharmacy reimbursement from PBMs to cover the cost to acquire and dispense prescription drugs.
    • Requiring National Average Drug Acquisition Cost(NADAC) surveyparticipation to help establish benchmarksfor Medicaid reimbursementto retailpharmacies which canbe used to ensure fair reimbursementtopharmaciesin Medicaid managed care and in the commercialmarkets.
  • Requiring the Centersfor Medicareand Medicaid Services(CMS)to defineand enforce"reasonable and relevant"Medicare PartDcontractterms,including information aboutreimbursementand dispensing fees,and establishing in Medicare PartDan approachbywhich "anywilling pharmacy" can trulyparticipateand serve patients.
  • Establishing relevant, standardized and transparent pharmacy quality measurements in Medicare Part D.

These,along with additional policies have been thesubjectofbipartisan and bicameral work across key committees ofjurisdiction,creating a robustpackage ofMedicare,Medicaid,and commercial marketreforms thatalso include:

  • Promoting transparency of insurer claimsand reimbursement information to the pharmacy, including independentaudits and enforcement measures in Medicare Part D.
  • Prohibiting PBM compensation in Medicare Part D from being tied to the manufacturer's list price of a drug.
  • Prohibiting spreadpricing in the commercialmarketbyrequiring 100%rebatepass- through ofrebatesandpaymentsfrom drug manufacturersto commercialhealthplansto lower beneficiarycostandensure adequate reimbursementfor pharmacyacquisitionand dispensing costs.

Again, we thank the Committee for its diligent investigation and we urge the Congress' enactment this year of what should be consideredmust-pass legislation: PBMreforms which the

Congress has developed and which Americans and their pharmacies desperately await.