WASHINGTON, Dec. 17,
2024 /PRNewswire/ -- The American Pharmacists
Association released the following statement after Congress's
response to the hundreds of APhA members' pleas to include major
federal PBM reforms in the end-of-year spending package set to pass
Congress this week.
Led by APhA's End Harmful Practices of PBMs Now campaign,
hundreds of APhA members called, wrote, and met with their members
of Congress to educate them on how PBMs' abusive and unchecked
business practices have directly led to pharmacy store closures
that have created unbearable pharmacy deserts that have denied the
only source of health care services to many underserved and rural
areas of the country.
"Pharmacy is united in standing up for our patients to reform
the broken PBM marketplace. For years, APhA has advocated for these
long overdue reforms to begin to stop PBMs' harmful business
practices that have robbed many communities of the necessary health
care services they have come to rely upon," said Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP,
executive vice president and CEO of APhA. "We thank our
congressional champions who understand there is more work to be
done. APhA and our colleagues will continue to lead the fight for
meaningful PBM reforms to keep our nation's pharmacy doors open for
our patients and bring real transparency and accountability to the
health care marketplace."
Key APhA-backed PBM reforms in the end-of-year spending package
include:
- Sec. 112. Ensuring accurate payments to pharmacies under
Medicaid. Requiring a survey of retail community pharmacy drug
prices to help establish benchmarks for Medicaid reimbursement to
pharmacies that can be used to ensure fair reimbursement to
pharmacies in Medicaid-managed care and in the commercial markets,
beginning six months after enactment of the spending package,
beginning the first quarter six months after enactment of the
spending package.
- Sec. 113. Preventing the use of abusive spread pricing in
Medicaid. Banning PBM spread pricing in Medicaid-managed care (the
overcharging Medicaid and underpaying of pharmacies) that has
created PBM profits at the expense of states and patients,
beginning in mid-2026.
- Sec. 226. Assuring pharmacy access and choice for Medicare
beneficiaries. Requiring the Centers for Medicare and Medicaid
Services (CMS) to define and enforce "reasonable and relevant"
Medicare Part D contract terms, including information about
reimbursement and dispensing fees, and an approach by which "any
willing pharmacy" can participate, beginning January 1, 2028.
- Sec. 227. Modernizing and Ensuring PBM Accountability.
Delinking PBM profits from the fake list prices set on prescription
drugs for plan years, beginning after January 1, 2028.
- Sec. 901. Oversight of pharmacy benefit management services.
Implementing PBM transparency measures to provide clear information
on drug pricing, rebates, and discounts in the commercial
marketplace for plan years, beginning two and half years after the
enactment of the spending package.
- Sec. 902. Full rebate pass through to plan. Requiring PBMs to
fully pass through 100 percent of drug rebates and discounts to the
employer or health plan.
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SOURCE American Pharmacists Association