In a move to address the long-standing issue of inflated prescription medication prices linked to pharmacy benefit managers (PBMs), bipartisan lawmakers recently introduced a new bill known as the “Pharmacists Fight Back Act.” The legislation, spearheaded by Reps. Jake Auchincloss and Diana Harshbarger, aims to curtail dubious business practices employed by drug supply chain middlemen that have been accused of driving up healthcare costs for U.S. patients and pharmacies.
The main goal of the bill is to ensure that community pharmacies can continue to provide quality care to patients enrolled in federal health-care programs while being fairly and transparently reimbursed by PBMs. Seniors covered by Medicare and Medicaid, government employees, active duty service members, and other patients would stand to benefit from lower health-care costs and increased freedom to select their preferred pharmacy for their prescriptions.
Last year, there was significant progress in pushing forward legislation targeting PBMs through House and Senate committees with bipartisan support. However, recent setbacks have stalled this momentum, as PBM reform was ultimately left out of a large government spending package earlier this year. Despite this, the Biden administration has intensified pressure on PBMs as many Americans grapple with the high costs of prescription drugs.
Focus on Pharmacy Practices
The “Pharmacists Fight Back Act” goes beyond previous legislation by placing a stronger emphasis on reforming pharmacy practices and increasing transparency around PBM business operations. The bill aims to hold PBMs accountable for certain practices, such as spread pricing, where plans are charged more than what pharmacies are paid for drugs. Additionally, the bill seeks to address the issue of pharmacists struggling as small business owners by providing them with the necessary resources to provide clinical and pharmacological advice to patients.
Some of the key reforms proposed by the bill include requiring PBMs to share 80% of rebates with patients, eliminating practices that steer patients to PBM-affiliated pharmacies, and prohibiting the exclusion of in-network pharmacies from filling prescriptions. By implementing these reforms, the bill aims to put an end to the exploitation of independent pharmacies, make life-saving drugs more accessible to patients, and generate savings for taxpayers.
New Reimbursement Model
One of the significant aspects of the bill is the introduction of a new pharmacy reimbursement model based on a drug’s national average drug acquisition cost (NADAC). This model ensures that pharmacies are reimbursed based on the actual cost of goods, particularly for generic prescription drugs. By shifting to a more transparent reimbursement system, the bill aims to address the ambiguity surrounding fees and markups in the current pharmacy payment structure.
Overall, the “Pharmacists Fight Back Act” represents a comprehensive effort to reform the practices of PBMs, protect the interests of pharmacies, and make prescription medications more affordable for patients. By targeting the root causes of inflated drug prices and questionable business practices within the drug supply chain, the bill seeks to create a fairer and more transparent healthcare system for all stakeholders involved.
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