Dear Colleague,
The "One Big, Beautiful Bill Act" passed the House in the wee hours of the morning last Thursday by one vote. It includes Medicaid managed care payment reform, one of our top priorities. But the nail-biting isn't over. It now goes to the Senate, where there is resistance. Senate leaders want a July 4 passage. If that happens, then it's back to the House, and then finally on to the president.
We're in a great position, but there's a long way to go. There's no good reason for our provision to be stripped out. It has strong bipartisan support, and the PBMs are a favorite Trump target. But, as we saw in December when PBM reform was washed out of the spending package, Congress often fumbles.
As another refresher, this legislation would change the payment model for Medicaid prescriptions to NADAC plus a dispensing fee decided by your state. Already states representing about one-third of the population have implemented "cost-plus" using NADAC as the cost. Yes, NADAC reporting will be required, but already large chains have started to report NADAC. Ask a colleague in a state that has cost-plus how it's working. Ask if they prefer a reasonable dispensing fee that is simple, transparent, and predictable, or the pittance they were getting previously. Some pharmacy owners have told me that cost-plus in Medicaid has kept their pharmacies open.
There are reasons to be optimistic. First, Medicaid managed care payment reform saves taxpayers almost $3 billion. That's important for paying for tax cuts. Second, President Trump has singled out the PBM "middlemen," who he correctly identifies as the main culprits driving up the cost of prescription drugs. He wants to show he's serious, and our provision is a good start. The bill would raise the debt ceiling, something that must happen this summer or the government will run out of money. Finally, the tax cuts passed under the first Trump administration will expire by the end of the year without this bill. It would amount to a massive tax increase, and Congress doesn't want to go into an election with that hanging over their heads.
In any event, we're not taking anything for granted. As I said before, Congress could still fumble. So, we're restarting the Finish the Fight campaign. We'll be asking you to contact your members of Congress again. But there's a twist. In addition to sending letters (NCPA members sent thousands last year), we're also asking you to get loud on social media. If you don't have an account on X (formerly Twitter), please consider getting one. Most of you have accounts on Facebook and LinkedIn, and we'll be using those platforms too. But X is real-time. It's where political conversations often go viral. It's a great way to engage your fellow pharmacists and patients. And, as you may know, it's where President Trump and members of Congress hang out. We need to get their attention.
You'll be getting instructions from our grassroots team on how to raise the roof on social media. You can start by following NCPA on X (@Commpharmacy), and you can follow me too (@RPhDouglas). Join the conversation by "liking" or "reposting" what we say, and, most importantly, "tag" your members of Congress so they see your posts. Keep your posts professional and to the point.
At the same time, we'll be targeting the White House and Congress with our message on multiple platforms and across the internet. And our advocacy team will continue pushing members of Congress to make sure our priorities are included in the Big, Beautiful Bill.
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
