In a groundbreaking move, bipartisan lawmakers have introduced a new bill aimed at tackling the exploitative practices of drug supply chain middlemen that have led to inflated prescription medication prices, causing significant harm to U.S. patients and pharmacies alike.
The newly proposed “Pharmacists Fight Back Act” seeks to address the concerns of community pharmacies and ensure that they can provide quality care to patients enrolled in federal health care programs. The key focus of the legislation is to guarantee fair and transparent reimbursement for pharmacies by pharmacy benefit managers (PBMs).
The bill promises a positive outcome for a wide range of patients, including seniors covered by Medicare and Medicaid, government employees, and active-duty service members. By implementing this legislation, these individuals are likely to see a reduction in healthcare costs and gain more freedom in selecting their pharmacy of choice for prescriptions.
The move comes at a crucial time, with the House Oversight and Accountability Committee conducting a hearing on the strategies employed by drug middlemen that contribute to escalating healthcare costs. It is vital to address the allegations against some of the largest PBMs, including UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts.
The initiative to reform PBMs is part of a growing trend across federal and state levels, with various bipartisan efforts in place to hold these middlemen accountable. Lawmakers and drug manufacturers have long criticized PBMs for overcharging plans, underpaying pharmacies, and failing to pass on savings to patients.
While previous PBM reform proposals have gained bipartisan support, progress has stalled on implementing new legislation. Despite the momentum building last year, Congress excluded PBM reform from a significant government spending package earlier this year. However, increasing pressure from the Biden administration signals a renewed push for change.
The comprehensive nature of the new bill sets it apart from previous reform efforts. Rep. Jake Auchincloss emphasized that this legislation is more substantial and tougher, particularly in its focus on improving conditions for pharmacies. By prioritizing pharmacists’ perspectives, the bill aims to empower small business owners and enhance patient care.
A fundamental aspect of the bill is the introduction of a new pharmacy reimbursement model based on the national average drug acquisition cost (NADAC). This approach seeks to align reimbursement with the actual cost of acquiring medications, fostering transparency and accountability in pricing mechanisms.
The “Pharmacists Fight Back Act” includes several critical provisions aimed at curbing exploitative practices within the pharmaceutical supply chain. Among these provisions are the requirement for PBMs to share a significant portion of rebates with patients and the prohibition of certain detrimental practices, such as steering patients toward branded medications over generic alternatives.
The introduction of the “Pharmacists Fight Back Act” represents a significant step toward addressing the challenges posed by rising prescription drug costs and the influence of PBMs in the healthcare system. By prioritizing the interests of pharmacies and patients, this legislation sets a new standard for comprehensive PBM reform at the federal level.