Feb 29, 2024
While it was difficult to watch Congress take PBM reform provisions off the table during the last round of government funding negotiations, we now have a unique opportunity to address a glaring omission from Congress’ proposed PBM reforms in Congress: ensuring federal legislation creates a fair and equitable business environment for pharmacies free from PBM greed and financial retaliation.
Last month we surveyed pharmacy owners about the current slate of PBM reform legislation and what their own legislative priorities are. Some 224 pharmacy owners responded, telling us their top 5 priorities are:
1. Ban PBMs from reimbursing pharmacies below drug acquisition cost
2. Require pharmacies be paid a professional dispensing fee
3. Ban DIR fees. Entirely.
4. Ban PBMs from steering patients to PBM-owned/affiliated pharmacies
5. Ban PBM spread pricing
Every respondent said they appreciated federal efforts to reform current PBM practices and hoped Congress would remember to include provisions that protect the business of pharmacy.
The most important message we can give to Congress is this: patient access begins with an open pharmacy. But pharmacies cannot sustain if they are not, minimally, made whole for drug acquisition cost and the costs associated with dispensing (bottles, bags, counseling, etc). Pharmacies are and have been the fallback for various PBM revenue streams - nickel and dime-ing pharmacies with claims adjudication fees; assessing overly punitive audit fines for minor, easily correctable mistakes; arbitrarily decreasing pharmacy reimbursements while openly engaging in jaw-dropping spread pricing toward plan payers.
And, though it should go without saying, no business can sustain if its larger competitor not only dictates how much it will make, but has the power to steer and direct customers away to its own store. That’s Business 101, and yet PBMs are legally allowed to steer patients away from network pharmacies to PBM-owned pharmacies in most states.
NCPA’s “Fight4Rx” campaign includes a QR code you can post in your pharmacy that allows pharmacy staff and patients to contact their legislators to share their support for laws that will allow pharmacies to remain open and preserve patients’ right to use their pharmacy of choice.
We have this opportunity, however small or fleeting, to include provisions that will resolve the most pressing issues that have been driving small business pharmacies out of the market for more than a decade. Let’s do this!
To Access a copy of the Fight4Rx QR code to use in your pharmacy, visit our Pharmacy Resources page: TruthRx.org/theevidenceupload