Pharmacy groups demand Congress act now on PBM reform

WASHINGTON— In an open letter, a unified coalition of pharmacy organizations called on congressional leaders to urgently pass critical reforms targeting pharmacy benefit managers in Medicare and Medicaid. The coalition’s letter underscores widespread bipartisan support for measures addressing PBM practices that inflate drug costs, shutter pharmacies, and limit access to care.

NACDS lauds leadership, urges action as members of Congress call for enactment of PBM reform this year

NACDS presses for PBM reforms necessary for Americans in Medicaid and Medicare and for their pharmacies.

Chain Drug ReviewCDR

NACDS poll: Voters say PBM reform is ‘must-pass legislation’

A recent NACDS poll highlights strong voter support for PBM reform and the significant influence healthcare issues had on voters’ decisions in the 2024 elections.

Chain Drug ReviewThorvardur de Shong

The coalition includes prominent groups such as the National Association of Chain Drug Stores, the National Community Pharmacists Association, and the American Pharmacists Association. Its message is that Congress must act this year to enact reforms that protect patients, pharmacies, and taxpayers.

Key legislation under consideration includes the bipartisan “Lower Costs, More Transparency Act” (H.R. 5378), the Senate’s Modernizing and Ensuring PBM Accountability (MEPA) Act (S. 2973), and the “BETTER Act of 2023” (S. 3430). Together, these measures aim to curb harmful PBM practices by increasing transparency, ensuring fair pharmacy reimbursements, and banning spread pricing in Medicaid.

NACDS to 118th Congress: Now, let’s get PBM reform done

“Soon a new administration and a new Congress will assume the mantle of leadership. Our nation’s pharmacies and pharmacy teams – the face of neighborhood healthcare – stand ready to work with them for sound policy of importance to all Americans.

Chain Drug ReviewCDR

“For over 15 years, pharmacists have raised alarms about PBM tactics that hurt patients and pharmacies alike,” the coalition wrote. “These practices have only worsened, siphoning dollars away from reducing prescription drug costs and compromising access to trusted pharmacies.”

The coalition detailed key reform priorities, including:

• Requiring 100% pass-through of costs and fees to pharmacies in Medicaid managed care.
• Ensuring fair and adequate pharmacy reimbursements to cover dispensing costs.
• Mandating participation in National Average Drug Acquisition Cost (NADAC) surveys to establish fair benchmarks for Medicaid reimbursements.
• Strengthening Medicare Part D with clear, enforceable contract terms and transparent pharmacy quality measures.
• Prohibiting PBM compensation tied to drug list prices and banning spread pricing in commercial markets.

The coalition emphasized that bipartisan recognition of PBMs’ detrimental practices is widespread among policymakers, patient groups, employers, and health advocates.

NCPA: Making America Healthy Again starts with PBM reform

The National Community Pharmacists Association in a statement urged incoming HHS Secretary RFK Jr. to prioritize reforming PBMs and insurers.

Chain Drug ReviewCDR

“With robust legislative work completed, Congress has a unique opportunity to pass reforms that ensure fairness, transparency, and sustainability in the pharmacy sector,” they concluded. “The time to act is now.”

As the legislative session nears its end, the pharmacy sector and its advocates await decisive Congressional action to deliver long-overdue reforms benefiting patients and pharmacies nationwide.