ALEXANDRIA, Va. (July 26, 2023) – The National Community Pharmacists Association is pleased to support the Modernizing and Ensuring PBM Accountability Act, which is a comprehensive pharmacy benefit manager reform package sponsored by Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho). The package advanced out of the committee today in a bipartisan vote of 26-1. The next step would be a vote before the full Senate, followed by possible consideration in the House of Representatives.
The package contains several provisions to enhance transparency into PBM-insurer operations, improve patient access to community pharmacies, and ensure fair pharmacy reimbursements that are based on actual acquisition and dispensing costs. Among other things it includes language from two bills that are NCPA priorities:
- The Drug Price Transparency in Medicaid Act (S. 1038), which ensures pharmacies operating in Medicaid managed care are reimbursed at a rate based on average acquisition cost and the state fee-for-service dispensing fee.
- The Protect Patient Access to Pharmacies Act (S. 2052), which reforms Medicare Part D by clarifying and providing enforcement tools for the any willing pharmacy law. It accomplishes this through reforms of performance metrics, claim-level transparency, and reimbursement that at a minimum covers a pharmacy’s costs to acquire and to dispense a covered drug to beneficiaries. This legislation completes pharmacy DIR fee reforms that were finalized by the Biden administration last year.
Additional provisions of note would delink PBM compensation from the cost of medications so that PBMs are no longer benefiting from ever-increasing list prices and rebates and would require PBMs to disclose criteria used to classify drugs as specialty to prevent patient steering to PBM-affiliated specialty pharmacies.
“PBM-insurers have gotten away with their anticompetitive, damaging tactics for too long. Independent pharmacies and the patients they serve need the transparency and relief that the reforms in this package will help provide,” said Anne Cassity, senior vice president of government affairs at NCPA. “The Senate Finance Committee has been leading the way in Congress when it comes to examining PBM-insurers, having first held a hearing on this issue back in 2019. In the time since, Chairman Wyden, Ranking Member Crapo and their colleagues and staff have worked hard to understand the issues at hand and develop a package to address them. We’re grateful for the committee’s tireless efforts and are eager partners in seeing that comprehensive PBM reforms move through the process and are signed into law.”
Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 19,400 pharmacies that employ nearly 240,000 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 www.ncpa.org.