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Pharmacy orgs urge Congress to finish bipartisan work on PBM reforms in Medicare, Medicaid

Pharmacies and pharmacists are urging the U.S. Congress to capitalize on the bipartisan work for pharmacy benefit manager reform in the 118th Congress and to enact crucial protections in Medicare and Medicaid.

In a letter to the Congressional leadership and to all members of Congress, the National Association of Chain Drug Stores, the National Community Pharmacists Association, FMI – The Food Industry Association, the National Grocers Association, the American Pharmacists Association and the National Association of Specialty Pharmacy state:

“For pharmacists and pharmacies serving patients and communities throughout the nation, we urge Congress to enact necessary pharmacy benefit manager (PBM) reforms without delay to reduce Americans’ prescription drug costs and to sustain healthcare access.

“Methodically, and with bipartisan and overwhelming support, PBM reforms to protect Americans in Medicare and Medicaid have advanced in the U.S. Senate and U.S. House of Representatives.

“Among the essential reforms advanced in the 118th Congress are:

Medicaid managed care pharmacy payment reform and a ban on spread pricing; defining and enforcing reasonable and relevant Medicare Part D pharmacy contract terms; and establishing relevant, standardized and transparent pharmacy quality measurements in Medicare Part D.

“On December 14, 2023, the Centers for Medicare & Medicaid Services wrote to PBMs and plans: ‘We are hearing an increasing number of concerns about certain practices by some plans and [PBMs] that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.’

“Be aware, as of January 2024 the harmful and aggressive tactics of some PBMs affecting Americans and their pharmacists and pharmacies seem to have gotten even worse. Many of our members report that some PBMs now are reimbursing pharmacies even further below the pharmacies’ cost for the prescriptions that they fill – especially in Medicare.

“Americans deserve and expect protection from inflated prescription drug costs, from forced pharmacy closures, and from barriers to their pharmacy of choice that result from PBM tactics. Please act now: Congress must not delay these crucial reforms in Medicare and Medicaid.”

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