The fight for pharmacy benefit manager (PBM) reform continues, with independent pharmacists playing a crucial role in highlighting anti-competitive practices. Recent events in Washington D.C. underscore the growing momentum for change, focusing on the impact of PBMs on drug costs, patient choice, and the viability of community pharmacies.
Independent Pharmacists Voice Concerns at White House Roundtable
On March 4th, 2024, a White House roundtable brought together key stakeholders, including Federal Trade Commission (FTC) Chair Lina Khan, Health and Human Services Secretary Xavier Becerra, and two members of the National Community Pharmacists Association (NCPA). The discussion centered on anti-competitive PBM practices impacting American families and community pharmacies.
Dr. Dared Price of Graves Drug in Kansas and Oread Rx, a transparent pass-through PBM, and Dr. Chichi Ilonzo Momah, owner of Springfield Pharmacy in Pennsylvania, represented independent pharmacists. Dr. Price advocated for an end to coercive PBM contracts, unfair reimbursement practices, and patient steering tactics. He highlighted how the largest PBMs exploit the opaque system, manipulating incentives and concealing revenue streams. He also emphasized that state-level legislative efforts protecting patients from PBM conflicts of interest do not increase health insurance costs, contrary to PBM claims. Dr. Momah shared real-world examples of navigating PBM red tape on behalf of her patients, urging policymakers to enforce existing regulations, consider a cost-plus reimbursement model for Medicaid managed care and Medicare Part D, and ensure transparent and fair pharmacy reimbursement based on acquisition cost plus a dispensing fee.
NCPA President Addresses Small Business Concerns at Virtual Town Hall
NCPA President Lea Wolsoncroft, owner of Remedies Pharmacy in Alabama, participated in a virtual town hall co-hosted by the Small Business Rising Coalition. The event focused on curbing monopoly power and promoting fair competition for small businesses. FTC Chair Lina Khan also participated, discussing the need to look beyond claimed efficiencies to determine whether dominant firms are leveraging unfair advantages. Wolsoncroft questioned Khan about the recently released merger guidelines from the FTC and Department of Justice, specifically regarding the “route to market” terminology and changes in how market share would be assessed for merged firms with a market share exceeding 30 percent, and whether these changes were made with PBMs in mind. While Khan refrained from commenting on specific industry applications, she acknowledged the FTC’s scrutiny of PBMs based on feedback from independent pharmacists, patients, and others regarding their practices.
The Push for PBM Reform Continues
These events highlight the continued efforts to address PBM practices and their impact on the healthcare system. The insights shared by independent pharmacists offer valuable perspectives on the challenges faced by patients and community pharmacies. The focus on transparency, fair competition, and patient choice underscores the need for comprehensive PBM reform. For patients seeking optimal care and affordable medications, consulting with a healthcare professional is crucial for navigating the complexities of the pharmaceutical landscape.
