From the FTC, to the halls of Congress, to reports from 3 Axis Advisors and white papers from APCI, the unscrupulous practices of large PBMs were exposed like never before in 2024 and the legislative climate and momentum for reform of PBM practices reached a fever pitch.

Reforms on the table included transparency reporting and Representative Buddy Carter’s Medicaid managed care reforms (reimbursement at NADAC +, spread pricing ban, mandatory NADAC reporting) included on Lower Costs More Transparency Act, revisions in Medicare Part D including delinking, transparency reporting, and reasonable and relevant contract terms for independent pharmacies, as well as delinking and transparency in commercial market. These solutions were on the table and thought to be in the year-end package before ultimately becoming a casualty in the eleventh hour. APCI supported the reforms to be included in the year-end package but also maintained they did not go far enough to protect independent pharmacies and their patients and even if those had passed, that would be the beginning and not the end of PBM reform.

Enter the Pharmacists Fight Back Act (PFBA, HR 9096), introduced by Representatives Jake Auchincloss and Representative Diana Harshbarger in July, the same day as a House Oversight hearing on the issue.

https://oversight.house.gov/hearing/the-role-of-pharmacy-benefit-managers-in-prescription-drug-markets-part-iii-transparency-and-accountability/

APCI was proud to collaborate on this legislation which looked to address PBM abuses in large federal healthcare plans (Medicare Part D, Medicare Adv., Medicaid managed care, Tricare, Federal Employees Health Benefits Program) including without limitation:

• Taking away the ability of PBMs to set and manipulate drug prices;
• Requiring pharmacy reimbursement to be based on a NADAC + + model;
• Prohibiting patient steering;
• 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;
• Requiring rebates be shared with patients at the counter; and
• Imposing criminal penalties for PBM violations.

APCI focused significant effort in obtaining cosponsors for PFBA and laying the ground work for the solutions proposed in PFBA to be on the table for 2025. APCI’s effort included working closely with PUTT and several state associations and other groups to establish a grassroots effort in reaching 50 cosponsors for PFBA by Thanksgiving. This goal was achieved and the year ended with a total of 56 Representatives signed on to the legislation.

Alabama, Massachusetts, and Texas lead the pack with four cosponsors each with Kentucky, Tennessee, and Georgia boasting three cosponsors. Garnering this level of support shattered any notion that there is not an appetite for protecting independent pharmacy or for aggressive PBM reform.

Read below for highlights of APCI’s efforts in connection with the PFBA and other advocacy initiatives.

July 2024: PUTT Summit

On the heels of PFBA’s introduction, APCI’s Greg Reybold joined Rep. Auchincloss for a conversation with PUTT members regarding the PFBA. Representative Auchincloss stated he has an ambitious goal of 50 cosponsors by Thanksgiving.

Sept. 19, 2024: PFBA Press Conference

APCI’s Cathy Hanna and Greg Reybold were joined by several APCI members, including APCI Board member Ron Poole and APCI members AJ Patel and Vic Johnson; PUTT CEO Monique Whitney; PUTT Executive Committee Board members Lauren Young and Brandi Chane; Kentucky Pharmacy Association CEO Ben Mudd; Tennessee Pharmacists Association CEO Anthony Pudlo; patient advocate Loretta Boesing; and several other pharmacists at a press conference in support of PFBA.

APCI was grateful for the Representatives who showed up and spoke in support of the PFBA:

• Representative Jake Auchincloss
• Representative Diane Harshbarger
• Representative Budzinski
• Representative Sanford Bishop
• Representative Ralph Norman

Representative Auchincloss speaks at PFBA Press Conference

APCI member and Georgia Pharmacist Vic Johnson speaks at PFBA Press Conference

Georgia Pharmacist Nikki Bryant speaks at PFBA Press Conference

September 2024 Business of Pharmacy Podcast

APCI’s Greg Reybold talked PFBA with Mike Khoelzer on the Business of Pharmacy Podcast

https://www.bizofpharmpod.com/pharmacists-fight-back-bill-hr-9096-targets-pbms-grey-reybold-attorney-american-pharmacy-coopera/

September 2024 PUTTcast

APCI’s Greg Reybold joined Representative Auchincloss on the PUTTcast with Pharmacists United for Truth and Transparency’s (PUTT) Executive Director Monique Whitney and PUTT Board member Lauren Young to discuss the PFBA.

https://music.amazon.com.au/podcasts/f5b31245-22a4-4a42-b989-03002e10e6b2/episodes/2cca3beb-537c-44a2-ab31-892fe0ac4bc2/the-puttcast-the-pharmacists-fight-back-act-a-conversation-with-greg-reybold

November 2024: APCI Post-election Drug Pricing Forum

The week after the election, APCI sponsored a drug pricing forum on Capitol Hill which educated health staffers on the PBM reform landscape with an emphasis on the PFBA. This forum featured drug pricing leaders Representative Auchincloss and House Oversight Chair Representative Comer. It also featured a panel moderated by APCI’s Greg Reybold with PUTT Executive Director Monqiue Whitney, Economic Liberties Project Senior Policy Analyst for Healthcare Emma Freer, and Dr. Marion Mass.

Rep. Jake Auchincloss

Rep. James Comer

PUTT Executive Director Monique Whitney, Economic Liberties Project Senior Policy Analyst for Healthcare Emma Freer, Dr. Marion Mass, APCI General Counsel & VP of Healthcare Policy Greg Reybold

December 2024: PBM Reform Podcast

APCI’s Greg Reybold joined Representative Auchincloss for a conversation with Todd Eury regarding the PFBA and the Patients Before Monopolies Act

https://pharmacypodcastnetwork.podbean.com/e/patients-before-monopolies-act-pbm-reform-podcast/

States

APCI remains active in member states and beyond supporting advocacy efforts through policy and political guidance, legislative drafting and review, and offering presentations and testimony.

September 2024: Mississippi PBM forum

APCI’s Bill Eley and Greg Reybold participated in an educational event organized by the Mississippi Independent Pharmacy Association which was well attended by state legislators, regulators, and employers. Speakers included Antonio Ciaccia of 3 Axis Advisors; Greg Baker, the CEO of AffirmedRx; and Greg Reybold.

October 2024: Georgia hearing on PBM landscape at Capitol

APCI’s Greg Reybold presented to members of the Georgia General Assembly on unfair practices of large PBMs.

November 2024: Alabama luncheon

APCI and Alabama Pharmacy Association hosted a PBM educational event for invited members of the Alabama General Assembly. Speakers included APCI’s CEO Tim Hamrick, APCI’s Greg Reybold, APA’s Bobby Giles, and APCI member Johnny Brooklere

November 2024: Comments to Arkansas Commissioner of Insurance

 APCI offered written comments in connection with the Commissioner of Insurance’s proposed rule regarding fair and reasonable reimbursement to independent pharmacies. APCI’s Greg Reybold provided comments in support of the proposed rule along with technical comments to ensure the rule was as strong as possible.

APCI Insights

APCI continues to shape drug pricing policy via expert input, testimony, and, now, a white paper series aptly names “APCI Insights.”  In the two most recent white papers, disparate treatment between independent pharmacies and mail-order pharmacies, and chain pharmacies are explored. Read them here:

https://bit.ly/apci-insights-002

https://bit.ly/apci-insights-003