WASHINGTON — The National Association of Chain Drug Stores (NACDS) is calling on pharmacy advocates and members of Congress to take urgent action following the Senate Parliamentarian’s removal of critical Medicaid pharmacy benefit manager (PBM) reforms from the budget reconciliation bill currently under consideration in Congress.
The removed provisions, a ban on PBM spread pricing in Medicaid managed care and the establishment of a reimbursement rate floor, had been included in both the House-passed bill and the version advanced by the Senate Finance Committee. Despite bipartisan support and broad backing from the pharmacy community, these reforms were struck from the package under the Senate’s Byrd Rule, which limits what can be included in reconciliation legislation.
Meanwhile, a controversial provision requiring mandatory pharmacy participation in the National Average Drug Acquisition Cost (NADAC) survey remains in the bill. NACDS and its allied organizations strongly oppose this language, particularly in the absence of accompanying PBM reforms, which were originally intended to be implemented together as a unified policy.
In a joint letter to Capitol Hill, NACDS and seven other pharmacy and grocery organizations expressed outrage at the removal of the reform provisions and warned of dire consequences if the NADAC mandate is allowed to pass without modification.
“Pharmacies already are closing at an alarming rate – approximately four closures per day. This crisis is only deepening,” the letter states. “By stripping out Section 71116, the ban on Medicaid managed care spread pricing and eliminating safeguards for fair and adequate reimbursement from PBMs, Congress is poised to continue to allow PBMs to proceed with their perverse manipulation of the system while pharmacies are left to collapse under below-cost reimbursement.”
The organizations stress that the NADAC survey, when implemented without PBM accountability, becomes another tool for PBMs to push reimbursements even lower — an outcome they call “regulatory overreach without protection.”
NACDS is urging pharmacy professionals and stakeholders to act now by contacting their lawmakers through the NACDS RxIMPACT grassroots platform. The association is also actively working on Capitol Hill alongside a coalition of national pharmacy and grocery organizations, including the National Community Pharmacists Association, the National Grocers Association, FMI – The Food Industry Association, and the American Pharmacists Association.
The message to Congress is clear: if PBM reforms are out, mandatory NADAC must also be out, and lawmakers must immediately establish a pathway for overdue PBM accountability.
The full text of the letter to Capitol Hill follows:
We write as pharmacies, pharmacists, and pharmacy employees across all practice settings, relied on and trusted for care by Americans in every community. Given the unjustifiable removal from the budget reconciliation bill of crucial Medicaid pharmacy benefit manager (PBM) reforms, we must insist on the elimination of the provision mandating participation in the National Average Drug Acquisition Cost (NADAC) survey. These two provisions were always meant to be moved together as one policy.
Pharmacies already are closing at an alarming rate – approximately four closures per day. This crisis is only deepening.
- By stripping out Section 71116, the ban on Medicaid managed care spread pricing and eliminating safeguards for fair and adequate reimbursement from PBMs, Congress is poised to continue to allow PBMs to proceed with their perverse manipulation of the system while pharmacies are left to collapse under below-cost reimbursement.
- Further, if Section 71115 (the mandatory NADAC survey) is enacted separate from necessary Medicaid PBM reforms, the PBM middlemen will be handed yet another tool to drive reimbursement even further below pharmacies’ costs. This would be regulatory overreach without protection.
PBM reform remains long overdue and Americans and their pharmacies are paying an increasing cost through drug price inflation, shuttered healthcare access points, and reductions in care.
Under no circumstance can this Congress once again turn its back on Americans and their pharmacies, and at the same time worsen an already desperate situation for every community throughout the nation. To reiterate: given the removal of the Medicaid spread pricing ban and assurances for fair and adequate Medicaid managed care pharmacy reimbursement, mandatory NADAC survey participation also must be removed. At the same time, Congress must establish an immediate pathway to enact the PBM reforms that have strong and broad-based support.
Sincerely,
National Association of Chain Drug Stores
National Community Pharmacists Association
National Grocers Association
FMI – The Food Industry Association
American Pharmacists Association
American Pharmacies
Independent Pharmacy Cooperative
Pharmacists United for Truth and Transparency
