A call for patients first and fair play in Washington

On March 3, two NCPA pharmacy owners participated in a special White House roundtable discussion on lowering health care costs, with a special emphasis on addressing pharma "middlemen" in the process. NCPA board member and pharmacist from Winfield, Kan., Dared Price addressed PBMs and vertical integration in his remarks, calling the practice of patient steering detrimental to pharmacists and patients. "We need to end take-it-or-leave-it PBM contracts and cut-throat reimbursements," said Price, who runs the transparent, pass-through PBM Oread Rx. Citing his experience filling the life-changing GLP-1s for people with diabetes, Price said his pharmacy was reimbursed $12,000 under cost in January, which is not unique to his experience, but "indicative of most brand name specialty reimbursement rates."

White HouseChichi Ilonzo Momah, a pharmacist and owner of Springfield Pharmacy in Delaware County, Penn., joined Price in raising the issue of "shrinking prescription reimbursements from PBMs when drug costs were increasing," she said. "Reimbursements continued to decline, and now negative reimbursements below the amount I pay for the medication are all too common." Momah also addressed the gaps that vertical integration leaves for America's most vulnerable populations by offering a window in the experiences of two of her patients.

"I implore CMS to consider a cost-plus reimbursement model not only in Medicaid fee-for-service which exists today, but also in Medicaid managed care programs and Medicare Part D. Pharmacies must be paid transparently and fairly based on acquisition cost plus a cost to dispense fee," she concluded. "This will save health care dollars and keep independent pharmacies in business to serve our patients."

Later in the week, on March 8, Momah introduced President Biden at a campaign stop on in Wallingford, Penn., and used the opportunity to spread the word about the anticompetitive practices of insurer-PBMs. "I'm passionate about advocating for the best health care possible for the patients of Delaware County. I've experienced firsthand the importance of hard work and perseverance. Through this I was inspired to become a Doctor of Pharmacy and a business owner. I was inspired by the American dream," she said to the packed house at Strath Haven Middle School. "Over the past few years, I have seen countless patients struggle to pay for basic medications like insulin and vaccines," Momah told the audience in Wallingford. Momah introducing Biden"Now I have a mission to contribute to this country by advocating for my patients. I fight for lower drug costs, bridging health care gaps, standing up to the middlemen—the pharmacy benefit managers—and big corporations. [I do this] all to support and give back to our community."

Fixing an untenable situation

PBM reform has been on NCPA's agenda for a long time now, and we continue to spread the word—especially on Capitol Hill, where over 10,000 messages written by independent community pharmacists have been sent since January. If you're still getting caught up, you can catch a special episode of Independent Rx Forum, NCPA's flagship podcast, to find out where we stand today on this urgent issue. Host John Beckner interviews Anne Cassity, NCPA senior vice president of government affairs, on the latest developments, why they matter, and how we can stop the closure of more independent pharmacies in the U.S.

Closure looms for lots of pharmacies. New data from NCPA shows that 32 percent of independent pharmacy owners may close their stores this year under pressure from plunging prescription reimbursements by big insurance plans and their pharmacy benefit managers—victims of the DIR hangover cash crunch. More than 92 percent say they may drop out of Medicare Part D, which would decimate patient access across the country, especially for senior citizens. More than half of all respondents say Medicare Part D prescriptions account for at least 40 percent of their business.

"This is an emergency," says NCPA CEO B. Douglas Hoey, "and if Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy."

NCPA has been actively engaging CMS on several fronts, all with the same message: do something. "The increased vertical and horizontal consolidation of PBMs and health plans has caused severe inequities to pharmacies and Medicare Part D beneficiaries alike. These are startling developments," said NCPA in a February 26 letter to CMS administrators. "Action is needed to ensure independent pharmacies can continue to serve their patients." Key congressional leaders received a copy of this letter as well.

Pharmacy owners are doing everything they can to avoid closing their doors, too. Forty-two percent got a line of credit to get them through the transition. Nearly 60 percent have had to use it. Many are cutting hours, reducing staff, and eliminating services. Nearly 70 percent, according to NCPA's data, have had to dip into their personal savings.

"We're still in the middle of the biggest fight of our lives as pharmacists," Hoey recently emailed members. "While the current outlook to include PBM reform in Congress' FY2024 funding package looks precarious, we must continue to remind Congress and the entire American electorate that the time to lower prescription drug prices and treat independent pharmacies fairly is now."

NCPA members: if you want to take action, there are two effective ways. First, by calling and emailing your legislators today, and telling them inaction is unacceptable, you can speak truth to power. Remember the reforms we are advocating are pro-pharmacy, pro-patient and pro-taxpayer—a win-win solution for everyone involved. Second, by attending our NCPA Congressional Pharmacy Fly-In, taking place April 17-18 in Alexandria, Va., and Washington, D.C., attendees can join forces with their colleagues to take the message directly to their representatives, face-to-face. Learn more and register today.