Dec 16, 2024
“Yes” on CR with specific Medicaid and Medicare reforms is essential to confront PBM tactics that inflate American’s prescription drug costs, force pharmacy closures, and block access to Americans’ pharmacies of choice

Washington, DC - Pharmacy organizations announced to the U.S. Congress today that they will “Key Vote” a “yes” on a continuing resolution including specific pharmacy benefit manager (PBM) middleman reforms.

The organizations include 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.

In a joint statement, the organizations stated: “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. As final negotiations proceed and it nears consideration in the House and Senate, we announce that each of our organizations will ‘Key Vote’ a ‘Yes’ on a continuing resolution with these specific reforms in Medicaid and Medicare.

“PBM tactics inflate American’s prescription drug costs, force pharmacy closures, and block access to Americans’ pharmacies of choice. The work done by Congress in the 118th Congress and in the crunch time of the past two weeks is vital and this moment simply cannot be allowed to slip by without finishing this job.

“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.”

Reports suggest that the healthcare package in the continuing resolution includes reforms consistent with these priorities with which pharmacies and pharmacists across all practice settings, and the organizations’ “Key Vote” includes a “Yes” on a continuing resolution containing them:

  • Medicaid managed care pharmacy payment reform and a ban on spread pricing by requiring 100% pass-through to the pharmacy of the ingredient cost and of the professional dispensing fee, which could allow the federal government and states to save billions of dollars.
     
    • Ensuring fair and adequate Medicaid managed care pharmacy reimbursement from PBMs to cover the cost to acquire and dispense prescription drugs.
    • Requiring National Average Drug Acquisition Cost (NADAC) survey participation to help establish benchmarks for Medicaid reimbursement to pharmacies that can be used to ensure fair reimbursement to pharmacies in Medicaid managed care and in the commercial markets.
  • Requiring the Centers for Medicare and Medicaid Services (CMS) to define and enforce “reasonable and relevant” Medicare Part D contract terms, including information about reimbursement and dispensing fees, and establishing in Medicare Part D an approach by which “any willing pharmacy” can truly participate and serve patients.