APCI Advocacy Quarterly: 4th Quarter Federal Update
PBM reform efforts remained hot at the federal level as 2023 came to an end. The U.S. House moved a significant piece of PBM legislation farther in the process than any other when it passed H.R. 5378 (read below) on December 11. There remain many PBM bills awaiting action at the federal level as 2024 begins (more than 50 PBM/drug pricing bills by our count).
That kind of attention is a good thing and is a testament to the work community pharmacy has done over the years to shine a light on PBM practices. However, while PBMs are facing headwinds like never before, they are not waving the white flag. Instead, large PBMs are engaging in a robust counter offensive in an effort to fend off meaningful PBM reform. They are doing this by, amongst other things, pointing the finger at drug makers and community pharmacists and also by making outrageous claims regarding the fiscal impact of PBM regulation.
In addition to PBMs launching a counter offensive, the fact remains that most of the solutions on the table at the federal level simply do not go far enough to protect community pharmacies and patients from the abusive tactics of large PBMs.
This means it is more important than ever to be an advocate for your profession. The good news is there are many ways to do that including through your support of APCI’s legislative affairs department. APCI would not be able to engage in the robust advocacy it does without support from members like you. So, thank you! If you would like to be even more involved, please reach out to APCI’s legislative affairs team for more information regarding hosting pharmacy visits, legislative outreach, how to submit an op-ed to a local paper, and more. APCI is gearing up for its most aggressive advocacy year ever and so opportunities to get involved will abound. Please keep reading to learn more about how the APCI advocacy team spent its fourth quarter in 2023.
APCI on Capitol Hill Part 1
APCI’s Greg Reybold outside the U.S. Capitol building
Reybold with Jess Wysocky, Legisative Director for Congressman Auchincloss
APCI’s Greg Reybold, along with its lobbying team at Arent Fox, spent two full days on the Hill. The trip included meetings with:
- U.S. Senate Committee on Finance staff members;
- U.S. Senate Committee on Health, Education, Labor, and Pensions staff members;
- U.S. House Committee on Oversight staff members;
- Congressman Auchincloss staff;
- Congressman Buchanon staff;
- Congressman Ferguson staff;
- Congressman Harshbarger staff;
- Congressman Scott staff;
- Senator Warren staff; and
- Attorneys with the U.S. Department of Justice.
APCI on Capitol Hill Part 2
Reybold with SmithRx SVP Alan Pannier after teaming up to advocate for PBM reform on the Hill
While in DC, Greg Reybold also met with Transparency-Rx, the new transparent PBM organization dedicated to advocating for transparency to discuss drug pricing and PBM reform. This included what we believe to be a first, community pharmacy and transparent PBMs teaming up on the Hill to advocate for PBM reform. You can read more about that here.
APCI presents at EPIC Pharmacies 2023 Legislative Summit
At the gracious invitation of EPIC, APCI’s Greg Reybold attended EPIC Pharmacies 2023 Legislative Summit and presented on PBM reform at the state level.
APCI and Transparency-Rx Letter for the Record to Senate Finance Committee
APCI and Transparency-Rx submitted a joint letter for the record to the Senate Finance Committee in connection with their November 8, 2023 hearing. The letter, not yet available online, highlighted findings in the new APCI sponsored 3 Axis Report as well as a recent MedPAC report. The letter praised the Committee for reporting the Better Metal Health Care, Lower Drug Cost, and Extenders Act (BETTER; S. 3430) for floor consideration but took issue with the comments of certain Committee members asserting that PBM reform was being driven by pharmaceutical manufacturers and their advocates. The letter drove home the fact that community pharmacy has long advocated for PBM reforms as have patient groups, and now, even transparent PBMs.
APCI presents at Georgia House Rural Development Council
At the invitation of the Committee Chairman, APCI’s Greg Reybold spoke with the Georgia House Rural Development Committee about opportunities for community pharmacists to provide much needed care in medically underserved areas as well as the threat to community pharmacies from the practices of large PBMs. Members can read about the presentation here.
Members can also watch the presentation here (1:20 mark).
Times Square Investment Journal quotes APCI
In a story on the role integration in the insurer/PBM space has on rising prices, APCI was quoted several times. Members can read the article here.
APCI applauds House’s work on PBM reform but calls for more action
In a December 12, 2023, Press Release, APCI applauded the House’s passage of the Lower Costs More Transparency Act of 2023 (H.R. 5378) but called on Congress to be more aggressive in its work on PBM reform. Members can read the press release here.
APCI meets with the FTC
In December, the APCI team met with high-ranking FTC staff to discuss large PBM practices and how their negative impact on competition and patient care. DIR fees and their role in driving up drug prices for patients while simultaneously harming community pharmacies was just one of the practices which was discussed.
Bill packages to watch
In December, the House took action, passing the Lower Costs More Transparency Act of 2023 (H.R. 5378) with a vote of 320-71. This bill includes important PBM revisions including reform of Medicaid managed care, a prohibition on spread pricing, and transparency. It will now make its way to the Senate for consideration.
Of course, the Senate will also be looking to take action on its own bills in 2024 with several key bills eligible for consideration on the Senate floor including Modernizing & Ensuring PBM Accountability Act (MEPA; S. 2973). This bill looks to tackle PBM conflicts of interest and increase transparency in Medicare Part D by delinking PBM profits from higher drug prices as well as requiring PBM reporting of certain information. In addition, the Committee on Finance introduced the Better Mental Health Care Lower-Cost Drugs, and Extenders Act (BETTER; S. 3430) which it favorably reported in November. Amongst other things, this bill addresses PBM practices centered around reimbursement of independent pharmacies, preferred network access for pharmacies, and lowering costs for patients for certain medicines via basing cost shares on prices net of rebates.
Not to be left out of the fray, the Senate Committee on Health, Education, Labor & Pensions (HELP) has advanced Pharmacy Benefit Manager Reform Act (S. 1339). This bill contains significant transparency reporting requirements, bans spread pricing, requires rebates to be passed through to plan sponsors, and prohibits PBM clawbacks. As previously noted, this bill would act on PBMs in the commercial market but fails to include language preserving state’s ability to regulate PBMs in the commercial and self-funded markets. Without such language it is likely PBMs would argue this legislation reshuffles the deck in terms of ERISA preemption.