Dear Colleague,
As you know by now, Congress has tried twice to pass a short-term plan to fund the government. The government will shut down at midnight tonight if they can't get their act together. Plan A, which seemingly had broad bipartisan support, and which included NADAC-plus for state Medicaid programs and reasonable and relevant PBM contract terms for pharmacies in Medicare Part D, was derailed by a torrent of social media posts by Elon Musk and Vivek Ramaswamy, who run President-elect Trump's Department of Government Efficiency (DOGE). That spooked a big chunk of the Republican caucus, and eventually the President-elect signaled his opposition.
Yesterday, House leadership shifted to Plan B, a stripped-down spending package to fund the government for three months. Democrats objected because their add-ons were tossed overboard. They were joined by enough Republicans to kill it. Poof.
As I write this update (it's my third version in 12 hours!), House leaders are coming up with Plan C. There are no details. Also, anything that passes the House must pass the Senate. Whether they can avert a shut-down before Christmas is anybody's guess.
What's not in doubt is that our priorities are very much alive. In fact, they are among the only provisions that have bipartisan support in both houses. PCMA propaganda aside, national angst over the business practices of big health insurers and their PBM cronies has never been higher. We've argued that whatever Congress passes must contain PBM reform. In all the chaos this week, we did get some good news. Rep. Buddy Carter (R-Ga.) has been elected chair of the Energy and Commerce Health Subcommittee. The overwhelming majority of PBM reform priority legislation must go through that subcommittee.
In the meantime, we are reaching out to DOGE. Obviously, they're influential. And while we agree with their mission to cut waste, we want Musk and Ramaswamy to know that when they killed Plan A, they threw the baby out with the bathwater.
In a letter sent yesterday to William McGinley, general counsel for DOGE, I pointed out that PBM reform would save taxpayers $5 billion dollars. PBMs administer pharmacy benefits for Medicare Part D plans, Tricare, and the federal employee health benefits plan.
In other words, PBM reform would deliver everything DOGE was created to accomplish!
No matter what happens in the short term, we are well-positioned to get PBM reform passed in the near future! We still have the same bipartisan support. Trump supports it—he said twice on Tuesday he wanted to "take out the middlemen." And at some point, I believe, Musk and Ramaswamy will be cheerleaders for PBM reform because it is essential to their mission.
I know we've pushed you hard this year, but you fought like warriors and we're all very proud and grateful. As I said, we don't know what Congress will do next. Whether it's next week or next year, we will continue fighting for independent pharmacy owners and rallying you to call on your members of Congress until they do what their constituents and taxpayers are willing them to do—reform Big Health Insurance and their PBMs.
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
