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Published on Thursday, August 18, 2022

APhA Reminds Policymakers to Fix Broken PBM Marketplace to Compliment New Drug Pricing Law

(August 17, 2022) WASHINGTON, DC— The American Pharmacists Association (APhA) is pleased that the Inflation Reduction Act aims to lower health care costs for our nation’s seniors by

  • Eliminating all out-of-pocket costs for Medicare vaccines starting next year
  • Capping insulin copays at $35 for Part D and Medicare Advantage for plan years 2023–2025
  • Capping out-of-pocket drug costs for seniors in Medicare Part D at $2,000 a year starting in 2025

However, a major area not addressed in the new law that continues to drive up prescription drug prices paid by plan sponsors and patients is the uncompetitive and deceptive trade practices of large, vertically merged PBMs that target patients with chronic conditions and force them to use PBM-owned specialty, mail order, and network pharmacies.

“APhA is very pleased that the new law will help to improve seniors’ access to vaccinations for preventable diseases and lowers their out-of-pocket prescription drug costs at the pharmacy. Now, Congress needs to complete its work by ensuring that pharmacy doors remain open and address the largely unregulated and broken PBM marketplace,” stated Ilisa BG Bernstein, PharmD, JD, FAPhA, interim executive vice president and CEO of APhA.

One action Congress should take is to immediately pass the widely supported bill S. 4293, the Pharmacy Benefit Manager Transparency Act of 2022, which would make it illegal for PBMs to engage in “spread pricing,” where PBMs charge health plans more for a prescription drug than they reimburse a pharmacy, and then pocket the difference. S. 4293 would also prohibit PBMs from clawing back payments made to pharmacies, or arbitrarily, unfairly, or deceptively increasing fees or lowering reimbursements to offset reimbursement changes in federally funded health plans.

“PBMs’ anticompetitive business practices are putting many pharmacies out of business and creating ‘pharmacy deserts’ in minority and medically underserved communities. APhA looks forward to working with Congress and the Federal Trade Commission to return competition to the PBM and health care marketplace to truly lower prescription drug prices for our patients, protect our nation’s community pharmacies, and promote health care equity in our nation’s rural and underserved communities,” Bernstein concluded.

About APhA

APhA is the only organization advancing the entire pharmacy profession. Our expert staff and strong volunteer leadership, including many experienced pharmacists, allow us to deliver vital leadership to help pharmacists, pharmaceutical scientists, student pharmacists, and pharmacy technicians find success and satisfaction in their work and advocate for changes that benefit them, their patients, and their communities. For more information, please visit www.pharmacist.com. 

 

CONTACT:  
media@aphanet.org

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