APCI’s advocacy reports typically cover three-month periods but with what July had to offer, the APCI team felt the likely developments would be too good to wait for September! This report will cover quarter two of 2024 (April-June) plus July for the bonus.
APCI continues to remain engaged in states, including sending out open records requests, participating in a study committee, assisting with drafting legislation, educating employers, speaking with reporters, and attending state conventions.
On the national stage, PBM reform continues to heat up! Both the New York Times and the Wall Street Journal offered blistering coverage of problematic PBM practices; 3 Axis Advisors pubilished a groundbreaking report on the divergent experiences between pharmacies and employers in Washington State; the FTC issued an interim report in connection with their 6(b) study; and the House Oversight committee conducted a blockbuster hearing on July 23 in which executives for CVS, Express Scripts, and Optum were placed under oath and questioned for several hours.
If the hearing was not enough, that same day U.S. Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN) introduced H.R. 9096, the Pharmacists Fight Back Act. This is the most aggressive PBM reform bill to be introduced at the federal level. APCI is proud to have worked closely with Representatives Auchincloss and Harshbarger in connection with its drafting and introduction.
Advocate for your profession
Pharmacist participation in the legislative process is the central ingredient for success at the state and federal level. That means you! As you will read below, H.R. 9096 is, in many ways, the bill independent pharmacy has been waiting for and offers meaningful relief and protection from abusive PBM practices. Congressman Auchincloss has set a goal of 25 democrat cosponsors and 25 republican cosponsors. We think we can do it, but we need your help to make that happen!
Please reach out to your U.S. Representative and ask that they stand with independent pharmacists and their patients by cosponsoring H.R. 9096 – the Pharmacists Fight Back Act.
Please also reach out to your U.S. Senator and ask that they support other priority PBM reform:
- H.R. 5378: Includes Rep. Buddy Carter’s Medicaid managed care reform and transparency reporting;
- S. 2973: Delinks PBM profits from drug prices in Medicare and PBM reporting; and
- S. 3430: Requires independent pharmacies to be included in preferred networks in Medicare Part D, CMS to establish reasonable and relevant contract terms for pharmacies, and requires total reimbursement to be no less than NADAC.
H.R. 9096 – the Pharmacists Fight Back Act
While there has been no shortage of PBM reform and drug pricing legislation introduced at the federal level in 2023 and 2024, including those supported by APCI mentioned above, the reality is that much of the PBM legislation introduced at the federal level does little to nothing to help keep independent pharmacy doors open.
The Pharmacists Fight Back Act represents a paradigm shift in the approach to PBM reform at the federal level as it looks to fundamentally fix the payment model while protecting pharmacies and patients from unfair practices of large PBMs.
More specifically, the bill does the following in large federal healthcare programs:
- Implements a transparent pharmacy reimbursement model using market-based pricing benchmarked to the national average drug acquisition cost (NADAC). This bill would pay retail pharmacies fairly while capping drug costs to no more than NADAC + a fair dispensing fee + 2 percent, thereby preventing massive markups at PBM-owned and affiliated retail, mail-order, and specialty pharmacies;
- Removes the ability of PBMs to restrict patient choice via network exclusions;
- Prohibits PBMs from steering patients to PBM affiliated pharmacies;
- Prohibits several PBM practices including point of sale and retroactive fees, brand mandates, spread pricing, and tying reimbursement of a drug to outcomes, scores, or metrics;
- Requires that PBMs share 80% of rebates with patients at the counter while preserving 20% of rebate dollars for the purposes of suppressing premium growth;
- Strengthens NADAC by requiring mandatory reporting from all pharmacies that dispense outpatient drugs — including PBM mail-order and specialty pharmacies.
In addition, PBM violations of this act would constitute a felony punishable by up to a $1 million dollar fine and 10 years in prison per violation. There is also the ability for persons to bring a civil action on behalf of themselves and the federal government.
As icing on the cake, the Pharmacists Fight Back Act was introduced on the same day as the House Oversight hearing with Congressman Auchincloss announcing the legislation after grilling the CVS executive about CVS pricing as compared to NADAC. A highlight of that exchange has garnered over 8 million views on X/Twitter.
https://x.com/RepAuchincloss/status/1816530337301774449
The Pharmacists Fight Back Act can be found here:
https://www.congress.gov/bill/118th-congress/house-bill/9096?q=%7B%22search%22%3A%22hr+9096%22%7D
Other notable developments with the Pharmacists Fight Back Act:
APCI’s Greg Reybold visits the White House
APCI’s Greg Reybold visited the White House in May to discuss PBM practices in Federal Healthcare plans.
Reybold visits staff on Capitol Hill
APCI’s Greg Reybold visited Capitol Hill and discussed PBM reform with staff for Congressmen Palmer, Scott, the Energy and Commerce Committee, and Senator Warren amongst others.
APCI’s team visits state pharmacy association conventions
It has been state association convention season and APCI has attended several meetings with members and supporting association efforts. Visits include Bruce Harris in Alabama, Bill Eley in Georgia, Bill Eley and Cathy Hanna in Kentucky, and Bill Eley in Tennessee and Texas.
Bill Eley at GPhA Convention in June presenting PAC check with APCI Board member Brandall Lovvorn and APCI member and GPhA PAC Chair Dawn Sasine.
Bill Eley presented with bobblehead doll of himself at GPhA Convention.
APCI presents to FTC 6(b) team
In June APCI presented on state PBM laws to the FTC 6(b) team.
Open records and FOIA requests
APCI has been active in seeking records from the Georgia Department of Community Health under the Georgia Open Records Act as well as the U.S. Department of Defense re: Tricare and the Centers for Medicare and Medicaid Services under the Federal Freedom of Information Act. APCI has received some records and is currently awaiting others. These requests can play out over several months but obtaining key records can help instruct policy and reform efforts.
APCI Insights
APCI released its first issue of APCI Insights in June. In its June edition, APCI Insights delved into the Office of Inspector General audit of the American Postal Workers Union Health Plan’s pharmacy benefits administered by Express Scripts. The audit found more than $39 million in PBM overcharges including by way of withheld rebates and pharmacy fees.
Members can read APCI Insights here (site login required): https://www.apcinet.com/Portals/0/news/2024/07/APCI-Insights-001.pdf
Business of Pharmacy Podcast
In April, APCI’s Greg Reybold joined the “Business of Pharmacy Podcast” for a discussion on efforts to fight PBM bad practices with host Mike Koelzer.
https://www.bizofpharmpod.com/pbm-fight-state-to-federal-shift-greg-reybold/
Pharmacy Podcast Network
In May, Greg Reybold joined Georgia pharmacist Nikki Bryant and Podcast host Todd Eury to discuss Governor Kemp’s veto of a Georgia bill that would have required the PBM for the state health benefit plan to reimburse independent pharmacies in parity with chain pharmacies.
https://www.youtube.com/watch?v=BebeG4q2xIU
PBMs on the Rocks
In July, Greg Reybold appeared on the PBMs on the Rocks podcast for a conversation with host Jeremy Counts and author and anti-monopoly thought leader Matt Stoller for a conversation regarding PBMs.
https://www.youtube.com/watch?v=YiMcmXThZnM