NCPA in Response to Executive Order: PBMs, Health Care Vertical Mergers Need More Scrutiny

NCPA July 26, 2021

ALEXANDRIA, Va. (July 26, 2021) — Following President Biden’s executive order promoting competition in the U.S. economy, the National Community Pharmacists Association is urging greater focus on drug pricing and the health care sector. NCPA is specifically pushing the administration to address pharmacy direct and indirect remuneration fees, as well as examine anticompetitive conduct of pharmacy benefit managers and mergers involving PBMs.

In comments to the White House, NCPA CEO B. Douglas Hoey, pharmacist, MBA outlines several anticompetitive PBM behaviors that deserve attention for threatening patient access to care and the survival of small business community pharmacies while increasing PBMs’ dominant market share. These behaviors include discriminatory take-it-or-leave-it contracting; steering patients away from community pharmacies to those owned by or affiliated with PBMs; and conflicts of interest in plan designs, pricing lists, and some formulary exclusions.

Hoey also details a separate letter to Health and Human Services Secretary Xavier Becerra in which NCPA calls on him to include a fix for pharmacy DIR fees in the comprehensive drug pricing plan the executive order directs the agency to develop. Hoey emphasizes to the secretary that fixing DIR fees is the most important policy initiative for small business neighborhood pharmacies, which are increasingly pressured by the government’s ongoing failure to address this issue.

“The pharmacy industry is dominated by a handful of giant companies that are systematically choking off their smaller competition,” Hoey says. "Just three corporations control as much as 77 percent of prescription drug benefit transactions in the U.S. All of them own or have financial ties to pharmacy benefit managers and insurance companies that steer patients to their own corporate pharmacies and slash reimbursements for their competitors.

“President Biden’s focus on anticompetitive corporate behavior is a breath of fresh air and long overdue. NCPA and the independent pharmacies we represent appreciate the administration’s increased attention on consolidation and lack of enforcement, and we pledge to help policymakers any way we can to restore balance and fairness to health care sector and the broader U.S. economy.”

Click here for NCPA’s comments to the White House.

Click here for NCPA’s comments to HHS Secretary Xavier Becerra.


Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 21,000 pharmacies that employ approximately 250,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit