NCPA: We’re on the Verge of Groundbreaking PBM Reforms

But Congress must ignore big insurance and the PBM lobby’s last-ditch effort to scuttle reforms and pass the continuing resolution

/EIN News/ -- Alexandria, Va., Dec. 17, 2024 (GLOBE NEWSWIRE) -- The National Community Pharmacists Association (NCPA), which has lobbied for years for fairer prescription reimbursements and pharmacy benefit manager accountability, said today that community pharmacies are on the verge of groundbreaking and desperately needed PBM reform, as Congress readies a continuing resolution that includes two of the organization’s top priorities. 

“We’re very grateful that Congress has included NCPA’s top priorities in the continuing resolution, but now is not the time to celebrate, because the health insurance companies and their PBMs will try desperately to stop this measure from passing,” said NCPA CEO B. Douglas Hoey. “Independent pharmacists across the country have done the grassroots lobbying, the letter writing, the congressional visits, and all the news interviews. Their efforts and the NCPA team’s boots-on-the-ground lobbying have all put us in scoring position. Now we’re on the goal line, and we need to punch it into the end zone.”

Included in the CR is a provision that would require PBMs to reimburse pharmacies at NADAC plus the state’s fee for service dispensing fee for all Medicaid managed care programs in all 50 states. It would eliminate spread pricing and pay PBMs a flat administrative fee in all Medicaid managed care programs. The provision will save taxpayers approximately $1 billion over the next 10 years.

Another provision written into the CR would require the Centers for Medicare & Medicaid Services to establish reasonable and relevant contract terms, including pharmacy reimbursements, in Medicare Part D and create a mechanism for pharmacies to dispute contract violations and penalize PBMs. Medicare Part D prescriptions make up one-third of the average independent pharmacy’s business.

“The PBMs systematically reimburse pharmacies less than their cost to buy and dispense medicine. That guarantees huge financial losses and has led to thousands of pharmacy closures and a loss of access for patients,” said Hoey. “The provisions in this legislation will help ensure that pharmacies are reimbursed more fairly, and that their contracts with PBMs aren’t the completely one-sided, take-it-or-leave-it contracts currently offered by the PBMs and their big insurance plan owners.

“In the last two years, NCPA and our members and partners built a strong bipartisan majority in Congress in favor of these reforms, and we are grateful to all our champions on Capitol Hill for getting us to this point. Now it’s critical that Congress finishes the job and passes the continuing resolution.”

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Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 18,900 pharmacies that employ more than 205,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit www.ncpa.org.

Andie Pivarunas
                    National Community Pharmacists Association
                    703-600-1174
                    andrea.pivarunas@ncpa.org