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Published on Tuesday, November 9, 2021

PBMs enjoy the benefit of status quo in Congress’ swing-and-a-miss on reducing prescription drug costs

WASHINGTON, DC – Following the public release of the Build Back Better Act by the U.S. House of Representatives, the American Pharmacists Association (APhA) is disappointed that Congress did not include provisions to rein in the excessive pricing gymnastics played by massive pharmacy benefit managers (PBMs) within Medicaid managed care and Medicare Part D programs.

Simple reforms aimed at how PBMs distort and exploit our nation’s complex prescription drug supply chain were passed over in favor of other proposals that neglect the systemic problems that plague the core of our nation’s broken prescription drug pricing system.

As Congress focuses on lowering drug prices, enhancing competition, eliminating waste, and addressing healthcare disparities among marginalized Americans, the time is ripe to enact legislative fixes to ensure continued access and availability of pharmacies and vital pharmacist services across the country, particularly for our nation’s seniors. Federal action is needed now to end deceptive practices in Medicare Part D. PBMs force seniors to pay inflated amounts at the pharmacy counter—rushing them into catastrophic coverage—only to have PBMs claw significant portions of those dollars back from pharmacies after the fact. These “direct and indirect remuneration (DIR) fees” create significant unpredictability and chaos at the pharmacy counter and unnecessarily expose elderly, sick Americans to egregiously high co-pays to obtain their medications. Congress is also missing an opportunity to curb potential PBM fraud, waste, abuse, and unethical “spread pricing” in Medicaid programs.

APhA’s CEO and Executive Vice President Scott Knoer issued the following statement:

“At a time when the alarms are sounding across the country that PBMs are engaged in deceptive and anticompetitive trade practices that undermine the pursuit of efficient, accessible, and equitable care, Congress’ silence on needed PBM reform is deafening. When Medicaid directors and employers are openly shouting for reform, Congress is failing to answer the call. We will never solve our nation’s drug pricing crisis until lawmakers and regulators roll up their sleeves and finally pull the pencils and paper away from exploitative PBM middlemen who have been afforded carte blanche to name their prices using precious taxpayer dollars.”

About the American Pharmacists Association 

The American Pharmacists Association 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, while advocating for changes that benefit them, their patients, and their communities. For more information, please visit www.pharmacist.com

 

 

CONTACT: Renee Kalu

202.429.7532; rkalu@aphanet.org

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Author: Jamila Negatu

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