In recent news, bipartisan lawmakers introduced a new bill aimed at regulating the business practices of drug supply chain middlemen who have been under scrutiny for inflating prescription medication prices. This legislation, known as the “Pharmacists Fight Back Act,” addresses the concerns of U.S. patients and pharmacies by ensuring fair and transparent reimbursement for community pharmacies. The bill, introduced by Reps. Jake Auchincloss and Diana Harshbarger, is a step towards reducing healthcare costs for Medicare and Medicaid beneficiaries, government employees, and active duty service members, while also increasing patient choice in selecting pharmacies.
The Role of Pharmacy Benefit Managers (PBMs)
PBMs, such as UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts, play a significant role in negotiating rebates with drug manufacturers on behalf of insurers and federal health plans. They also create formularies of covered medications and reimburse pharmacies for prescriptions. However, lawmakers and drugmakers argue that PBMs overcharge plans, underpay pharmacies, and fail to pass on savings to patients. The new bill seeks to address these issues by increasing transparency in PBM practices, banning spread pricing, and holding PBMs accountable for sharing rebates with patients.
Legislation targeting PBMs has gained bipartisan support within Congress, with proposals advancing through House and Senate committees in the past year. However, the absence of PBM reform in recent government spending packages has stalled legislative progress. The Biden administration has increased pressure on PBMs, with the Federal Trade Commission planning to sue Caremark, Express Scripts, and OptumRx. The new bill introduced by bipartisan lawmakers represents a comprehensive effort to reform PBMs at the federal level and empower pharmacists in providing patient care.
One of the key components of the new bill is the introduction of a new pharmacy reimbursement model centered around the national average drug acquisition cost (NADAC). This model aims to align reimbursement with the actual cost of medications, particularly for generic drugs. By focusing on NADAC and eliminating the complexities of the current reimbursement system, the bill aims to ensure fair compensation for pharmacies and reduce ambiguity surrounding fees and markups.
The bill includes provisions that require PBMs to share rebates with patients, prohibit practices such as steering patients to PBM-affiliated pharmacies, and ensure patient access to affordable generic medications. By addressing these issues, the bill aims to protect independent pharmacies from unfair practices, make life-saving drugs more affordable for patients, and generate savings for taxpayers. Rep. Harshbarger emphasized that the bill’s reforms are crucial in stopping the exploitation of independent pharmacies and improving patient access to essential medications.
The fight against drug supply chain middlemen represents a critical step towards ensuring fair pricing, transparency, and patient choice in the healthcare system. The new bill introduced by bipartisan lawmakers reflects a comprehensive approach to reforming PBMs and protecting the interests of patients and pharmacies. As legislative efforts continue to evolve, the focus remains on empowering pharmacists to deliver quality care and combat corporate greed in the drug supply chain.