With the budget reconciliation process behind them, Congress must now act to pass the PBM reform provisions that were cut out of the process by the Senate parliamentarian.
Tell your members of Congress to support the PBM Reform Act (H.R. 4317), a comprehensive piece of legislation that addresses PBM bad practices that increase costs and limit patient choice and access to medications. Check here to see if your member of Congress has cosponsored the bill. If not, ask them to—and if they have, make sure to thank them for their support.
These reforms also include the following pro-pharmacy measures:
Medicaid managed care payment reform through enhanced transparency and a ban on spread pricing by reimbursing pharmacies at a rate equal to the national average drug acquisition cost (NADAC) plus the state's fee-for-service dispensing fee. This would also save taxpayers nearly $3 billion.
Medicare D contract reforms that require CMS to define and enforce reasonable and relevant contract terms in Part D, including terms related to reimbursements, and establish a mechanism for pharmacies to report violations.
Overall, the PBM reform provisions in the bill create over $5 billion in taxpayer savings.
Congressional action on PBM reform is long overdue. Pharmacy deserts are growing as pharmacies, both independent and chain, close their doors. This impacts tens of thousands of patients, and without prompt congressional action, the problem will continue to get worse. H.R. 4317 is a strong step forward and NCPA urges the swift passage of this important legislation.
Please contact Anne Cassity, Kaite Krell, or David Weissman with any questions.
