You took the fight to Capitol Hill—and PBM reform is in sight | NCPA Executive Update | April 19, 2024

NCPA April 19, 2024

Dear Colleague,

Doug HoeyThis has been a momentous week for pharmacy, and our David still has the courage to go after the Goliath of our generation: vertically integrated insurer PBMs. Hundreds of pharmacists from most U.S. states came to Washington this week to take up the fight on Capitol Hill. This has been the most important Congressional Pharmacy Fly-In to date if for no other reason than America lost one independent pharmacy each day of the calendar year in 2023 and that trend has continued into this year. PBM reform must be done, and it must be done now!

That's also the message we took to senior staff at the White House on Wednesday. NCPA leadership met with White House policy staff again to provide additional information about what is going on in the community pharmacy marketplace. NCPA President Lea Wolsoncroft, President-Elect Jeff Harrell, and Board Chair Kristen Riddle provided real world examples of reimbursement issues that threaten the ability of pharmacy teams to continue providing premium patient care services. Those services keep patients healthy and out of the E.R., hospital, or, in some cases, the morgue. NCPA Senior Vice-President Ronna Hauser provided insights on the regulatory landscape, and I was there to provide additional color commentary. We were encouraged by our meeting and, frankly, whether it be the White House, CMS, Congress, or the FTC, we will take help from any source. We just need help from our government to keep taxpayer programs like Medicare from running small businesses out of business!

Concurrent with our White House meeting and just a few blocks down Pennsylvania Avenue, our members spent most of the day Wednesday meeting with their elected members of Congress to push for—in no uncertain terms—changing the pharmacy payment model starting with Medicaid and Medicare, which represents over 50 percent of the average independent pharmacy's business. NCPA's top legislative priorities are federal legislation that would positively affect pharmacy reimbursement and help to stop the loss of patient access every time PBMs cause another local pharmacy to close.

For those of you who didn't or couldn't attend the Fly-In, it's important for you to let your legislators know you need their support. NCPA will be coming back to you with specific instruction, but for now, I encourage you to let your elected officials know you, your business, your employees, and your patients need PBM Reform, and you need it now! Their help is needed by supporting and passing:

  • The Neighborhood Options for Patients Buying Medicines (NO PBMs) Act Senate bill 2436 (S.2436) and House of Representatives bill 5400 (H.R. 5400). It requires CMS to define and enforce "reasonable and relevant" Medicare Part D contract terms—including reimbursement.

  • The Drug Price Transparency in Medicaid Act (S.1038) passed the House and now needs a vote in the Senate. It prohibits the use of spread pricing in Medicaid managed care programs and would move to a fair and transparent pharmacy reimbursement system based on average acquisition costs plus the state's Medicaid fee-for-service dispensing fee.

Congress, as one speaker said, doesn't always have "a fire in its belly." He encouraged the audience to "annoy" (respectfully) their representatives, so their issue stays top of mind. All in all, the 2024 NCPA Legislative Fly-In accomplished the goal of reminding Congress that community pharmacies need them to act. Urgently.


Doug Hoey

B. Douglas Hoey, Pharmacist, MBA