By Consumers for Quality Care, on January 10, 2024
The Biden administration wants to end the anticompetitive business practices used by health insurers and pharmacy benefit managers (PBMs), according to reports by Healthcare Dive. Experts say that these practices have driven up prescription drug prices and forced independent pharmacies out of business.
The Centers for Medicare & Medicaid Services (CMS) recently sent a letter to health plans and PBMs, calling on them to re-examine how they currently reimburse pharmacies. This comes on the heels on the Biden administration’s crack down on anticompetitive behavior found in other corners of the health care sector.
The National Association of Chain Drug Stores (NACDS), which represents pharmacies both large and small, applauded the letter, and called for more action against predatory PBM practices. “The tactics of market-dominant middlemen have pushed pharmacies of all types and sizes to breaking points that can only inflict negative consequences on the Americans who rely on trusted and convenient access to medications and to pharmacy services,” said NACDS President and CEO Steven Anderson.
Independent pharmacies are being squeezed from both sides: Fees from PBMs are too high, and reimbursements from PBMs are too low for these pharmacies to sustain their businesses.
If left unchecked, PBMs will continue to engage in anticompetitive business practices, forcing independent pharmacies to shut their doors and limiting how consumers access their medications. CQC urges lawmakers and regulators to continue scrutinizing these practices.