If not now, then when?

NCPA April 28, 2023

Dear Colleague,

Doug Hoey I have several t-shirts that ask, "If not me, then who?" and this week hundreds of pharmacy owners, their team members, and pharmacy students came to Capitol Hill to add, "If not now, then when?" as part of the NCPA Congressional Pharmacy Fly-In.

"PBMs act without consequence because they hide in the shadows and it's time to bring them into the light," said House Oversight Committee Chair, Rep. James Comer (R-KY) to kick things off ahead of the first day of Hill visits.

ComerHe shared that he got interested in PBMs because he heard from his local, Kentucky pharmacists that vertically integrated PBMs were the bane of pharmacy's existence. Chairing the House Oversight Committee is a big deal and the fact that Rep Comer is investigating PBMs and will be holding more hearings on PBMs was music to the ears of the audience!

The number of PBM transparency bills in Congress is starting to stack up. That's good but NCPA's long stated priority is to "Change the Pharmacy Payment Model." To do that, NCPA's priority legislation Drug Price Transparency in Medicaid Act, is a good step forward. This legislation is good for you and your patients because it protects taxpayers by blocking spread pricing by health insurer PBMs in Medicaid. Importantly, it also ensures fair and transparent pharmacy reimbursement in Medicaid programs.

If you were not at the Fly-In, do your part by reaching out to your legislators this week and asking for their support. NCPA has made it easy for you to do so by clicking here so you may communicate with your Congressional representatives. NCPA has outlined the issues, you just need to add your story and personal touch to the message.

If not now, then when?

In addition to the Drug Price Transparency in Medicaid Act, NCPA members were there in support of the Pharmacy Benefit Manager Transparency Act, driving transparency for employers and plan sponsors and holding PBMs accountable for unfair and deceptive practices. They were also there for the Equitable Community Access to Pharmacist Services Act, ensuring Medicare beneficiaries can easily access health care services by authorizing pharmacists to test and treat COVID-19, flu, respiratory syncytial virus, and strep throat.

BedoyaTransparency, fairness, and competition were also at the heart of my conversation on stage with Federal Trade Commissioner Alvaro Bedoya, who spoke about his interest in enforcing laws that are already on the books, like the Robinson-Patman Act, that were created to help balance tipped scales in the David versus Goliath business challenges community pharmacies face today with vertically integrated PBMs.

Robinson-Patman largely got shelved in the 1980s because of a perception that "bigger is better" and cheaper for consumers. Ever since then, Robinson-Patman Act challenges, despite being an important federal law, have largely gone dormant. But Commissioner Bedoya is interested in rekindling the law. He emphasized that there is no compelling evidence that "bigger" actually lowered consumer prices or improved the quality of service.

Bedoya's message is an urgent one for us to raise awareness of, especially given a recent poll by NPCA, which we announced yesterday. We talked to over 1,000 registered voters across the country—blue, red, and purple—and nearly three-quarters had little or no idea about the deleterious impact of PBMs. Once they knew, about 80 percent of them responded they were either "concerned" or "very concerned" about each and every one of those anticompetitive and, frankly, unethical PBM practices.

But, that's not the end of the fight. The consumer survey is yet another tool for community pharmacies to use to point out why pharmacy payment reform is needed pronto!

If not now, then when?


Doug Hoey

B. Douglas Hoey, Pharmacist, MBA