Independent Pharmacies Urge Congress to Pass PBM Reform
By Consumers for Quality Care, on October 30, 2024
Only a few months remain until a new Congress is sworn in, but according to reporting by The Washington Post, independent pharmacies are hoping that this Congress will meaningfully reform the pharmacy benefit manager (PBM) industry in the lame-duck session.
Independent and family-owned pharmacies across the country are struggling to stay in business because of the monopolistic practices of PBMs. According to Anna Cassity, Senior Vice President of Government Affairs at the National Community Pharmacists Association, roughly one independent pharmacy goes out of business each day. This threatens consumer access to vital prescription medications.
The three largest PBMs – Optum, Express Scripts, and CVS Caremark – have incredible market power, controlling roughly 85 percent of the prescription-drug market. This leaves independent pharmacies with little leverage to negotiate fair contracts with PBMs. They say that PBMs abuse this leverage, charging them high fees while also forcing them to accept low rates for reimbursement. These practices, according to independent pharmacy owners, are running them out of business, and there’s nothing that they can do to stop it, they say.
Regulators and lawmakers have attempted to rein in PBMs. This summer, the Federal Trade Commission (FTC) filed a lawsuit against the three largest PBMs over their price-negotiation tactics for critical prescription drugs, including insulin. Congressional committees have also launched investigations into the industry, and lawmakers on both sides of the aisle have called for reforms to increase transparency and reduce anticompetitive practices.
Last December, the House passed one bill to address the issue while the Senate passed another. Cassity hopes that one or both of these bills will pass both chambers and reach President Biden’s desk before the 118th Congress ends in January. “Lawmakers have done 18 months of substantive work on this issue, and it would be tragic if these reforms aren’t included in some sort of lame-duck package and finalized this year,” said Cassity.
If left unchecked, PBMs will continue to engage in anticompetitive business practices, forcing independent pharmacies to shut their doors, which in turn limits consumers’ access to medications. CQC urges lawmakers and regulators to continue scrutinizing PBM activities and to take action to ensure access to affordable care for all consumers.
