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WASHINGTON—A coalition of leading pharmacy organizations announced they will "Key Vote" a "yes" on a continuing resolution (CR) if it includes critical reforms targeting pharmacy benefit managers (PBMs), practices that drive up prescription drug costs, and threaten pharmacy access for Americans.
The coalition comprises the National Association of Chain Drug Stores, the National Community Pharmacists Association, the American Pharmacists Association, the National Association of Specialty Pharmacy, FMI – The Food Industry Association, the National Grocers Association, and the National Alliance of State Pharmacy Associations.
CDR
In a unified statement, the organizations emphasized the urgency of the reforms: "By most accounts, leaders in Congress have successfully negotiated a healthcare package for the continuing resolution that includes long-overdue and urgently-needed PBM reforms of critical importance to Americans and their pharmacies."
Highlighting the stakes, the statement continued: "PBM tactics inflate Americans' prescription drug costs, force pharmacy closures, and block access to Americans' pharmacies of choice. The work done by Congress...is vital and this moment simply cannot be allowed to slip by without finishing this job."
The proposed reforms in the healthcare package aim to:
Ban Spread Pricing: Medicaid managed care pharmacy payment reforms would require PBMs to pass 100% of ingredient costs and professional dispensing fees directly to pharmacies, potentially saving billions for the federal government and states.
Ensure Fair Reimbursement: Pharmacies would receive adequate Medicaid managed care reimbursement to cover drug acquisition and dispensing costs.
Establish Reimbursement Benchmarks: Participation in the National Average Drug Acquisition Cost (NADAC) survey would help set fair Medicaid reimbursement rates in managed care and commercial markets.
Define Reasonable Medicare Contract Terms: The Centers for Medicare and Medicaid Services (CMS) would be tasked with establishing clear and enforceable Medicare Part D contract terms, ensuring pharmacies receive transparent reimbursement and dispensing fees.
Support Pharmacy Participation: An "any willing pharmacy" provision would enable pharmacies to serve Medicare Part D patients without restrictive PBM contracts.
The pharmacy organizations expressed deep appreciation for legislative efforts thus far: "Americans and their pharmacies appreciate the work that Congress has exerted to get real PBM reforms to this point. It would be unthinkable to leave this work undone for all Americans and for their trusted pharmacies."
As the House and Senate near final deliberations on the CR, the pharmacy groups reaffirmed their commitment to supporting the measure if these reforms remain intact, stressing that the time for action is now.
