Last week, the Senate Finance Committee introduced S. 2973, the Modernizing and Ensuring PBM Accountability Act. Chairman Ron Wyden (D-Oregon) and Ranking Member Mike Crapo (R-Idaho) stated that this package would bring more transparency, accountability and competition to pharmacy benefit manager (PBM) practices in the pharmaceutical supply chain. This bill reflects the Chairman’s Mark that was reported out of the Finance Committee in July, containing several NCPA priorities including:
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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.
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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. NCPA thanks Chairman Wyden and Ranking Member Crapo for their leadership and looks forward to working with the committee as they proceed forward on negotiations with the final PBM package.
