Congress will vote on a continuing resolution to fund the government for the remainder of FY 2025 this week, and it includes the PBM reform provisions supported by NCPA, community pharmacies, and patients. Please call and email your legislators IMMEDIATELY and tell them to vote YES when it comes to the floor. We have resources to help you reach your legislator here.
The continuing resolution includes a provision requiring PBMs to reimburse pharmacies at NADAC plus the state's fee for service dispensing fee for all Medicaid managed care programs in all 50 states. It would eliminate spread pricing and pay PBMs a flat administrative fee in all Medicaid managed care programs. The provision will save taxpayers approximately $1 billion over the next 10 years.
Another provision requires the Centers for Medicare & Medicaid Services to establish reasonable and relevant contract terms, including pharmacy reimbursements, in Medicare Part D and create a mechanism for pharmacies to dispute contract violations and penalize PBMs. Medicare Part D prescriptions make up one-third of the average independent pharmacy's business.
"We're very grateful that Congress has included NCPA's top priorities in the continuing resolution, but now is not the time to celebrate, because the health insurance companies and their PBMs will try desperately to stop this measure from passing," said NCPA CEO B. Douglas Hoey.
"Independent pharmacists across the country have done the grassroots lobbying, the letter writing, the congressional visits, and all the news interviews. Their efforts and the NCPA team's boots-on-the-ground lobbying have all put us in scoring position. Now we're on the goal line, and we need to punch it into the end zone."
We need you to engage with your representatives on Capitol Hill to support the continuing resolution. Pharmacies can also help by displaying Finish the Fight materials and encouraging patients to scan the QR code and voice their support for PBM reform measures.
When you contact your legislator, tell them to support the bill because:
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These provisions are a good start for PBM reform
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PBM reforms create taxpayer savings
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PBM reforms have overwhelming bipartisan and bicameral support
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PBM reform cannot wait
