In
a
Friday
letter,
a
group
of
pharmacy
organizations
called
on
Congressional
leadership
to
take
action
on
pharmacy
benefit
manager
reform.
The
organizations
included
in
the
letter
are
the
National
Association
of
Chain
Drug
Stores,
the
National
Community
Pharmacists
Association,
the
Food
Industry
Association,
the
National
Grocers
Association,
the
American
Pharmacists
Association
and
the
National
Association
of
Specialty
Pharmacy.
The
letter
was
addressed
to
House
Speaker
Mike
Johnson
(R-Louisiana),
House
Minority
Leader
Hakeem
Jeffries
(D-New
York),
Senate
Majority
Leader
John
Thune
(R-South
Dakota)
and
Senate
Minority
Leader
Chuck
Schumer
(D-New
York).
PBMs
have
come
under
a
lot
of
scrutiny
in
recent
years
due
to
their
vertical
integration
with
insurers
and
practices
that
inflate
drug
prices.
The
top
three
PBMs
—
CVS
Caremark,
Cigna’s
Express
Scripts
and
UnitedHealth
Group’s
Optum
Rx
—
control
about
80%
of
the
prescription
drug
market.
Numerous
efforts
have
been
attempted
to
reform
PBMs,
though
with
little
success.
For
example,
in
December
2024,
the
federal
government
almost
passed
a
spending
bill
that
would
have
cracked
down
on
PBMs,
but
this
provision
was
taken
out
at
the
last
minute.
“Since
Congress’
near‑win
on
PBM
reform
in
December
2024
—
another
missed
opportunity
that
fell
just
short
of
enactment
—
the
devastation
of
pharmacy
access
for
patients
and
communities
has
only
worsened,”
the
letter
stated.
“In
the
months
since
that
lost
attempt
to
help
solve
the
problem,
pharmacies
have
closed
at
an
alarming
net
rate
of
more
than
six
per
day,
an
acceleration
of
the
nearly
four-per-day
net
closing
rate
of
2023
and
2024.”
The
organizations
added
that
in
just
the
last
year,
more
than
2,200
pharmacies
have
closed
and
Americans
have
lost
more
than
13%
of
their
pharmacies
since
January
2018
on
a
net
basis.
“The
failure
to
curb
harmful
PBM
practices
is
no
longer
a
crisis
in
the
making
—
it
now
constitutes
a
crisis
unaddressed.
…
Without
PBM
reform,
patients
are
experiencing
inflated
drug
costs,
and
many
no
longer
have
access
to
the
pharmacy
of
their
choice
as
pharmacies
close
and
others
are
pushed
out
of
network.
Americans
expect
Congress
to
address
these
perils,”
they
said.
Specifically,
the
coalition
called
for
the
following
reforms:
-
Medicaid
managed
care
pharmacy
payment
reform
and
a
ban
on
spread
pricing,
in
which
a
PBM
charges
payers
more
than
they
pay
the
pharmacy
for
a
medication
and
then
keeps
the
difference
as
profit. -
Requiring
CMS
to
define
and
enforce
fair
Medicare
Part
D
contract
terms
and
ensure
true
“any
willing
pharmacy”
participation. -
Banning
PBM
compensation
in
Medicare
Part
D
from
being
linked
to
the
list
price
of
a
drug. -
Promoting
greater
transparency
in
insurer
claims
and
reimbursement
practices
provided
to
pharmacies.
“As
Congress
approaches
key
deadlines,
we
respectfully
request
that
PBM
reform
be
included
in
the
next
appropriate
moving
vehicle
or
advanced
as
a
stand‑alone
measure,”
the
organizations
wrote.
“The
consensus
is
broad,
the
policy
is
developed,
and
the
consequences
of
inaction
are
compounding.
We
stand
ready
to
assist
with
swift
enactment
and
implementation.”
This
letter
comes
shortly
after
a
bipartisan
bill
was
introduced
in
the
Senate
this
month
called
the
PBM
Price
Transparency
and
Accountability
Act.
It
includes
several
provisions,
including
delinking
PBM
compensation
from
negotiated
rebates
and
increasing
reporting
requirements
for
PBMs
to
Medicare
Part
D
plan
sponsors
and
HHS.
Photo:
gerenme,
Getty
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