NACDS is lauding legislation introduced by U.S. Senators Peter Welch (D-VT) and Roger Marshall (R-KS) to crack down on tactics by which “pharmaceutical benefit manipulator” middlemen maximize profits at the expense of patients, pharmacies, and others.
The bill – S. 1038, the Drug Pricing Transparency in Medicaid Act – would block middlemen tactics in Medicaid managed care that drive up prescription drug prices and that force pharmacies to provide medications below their cost to acquire and dispense them.
The Senate bill is the companion to H.R. 1613, introduced in March by U.S. Reps. Buddy Carter (R-GA), Vicente Gonzalez (D-TX), Elise Stefanik (R-NY), Deborah Ross (D-NC), Rick Allen (R-GA), and Jake Auchincloss (D-MA).
NACDS President and CEO Steven C. Anderson said: “In the U.S. Congress, we are seeing bipartisan commitment and work across the Senate and the House of Representatives to deal with the problems created by ’PBMs’ – appropriately called ‘pharmaceutical benefit manipulators.’ The introduction of this Senate legislation is another critical step in the campaign to remedy PBMs’ complication and exploitation of the system for their own profit and at the expense of patients, communities, employers, taxpayers, and pharmacies.
“NACDS backs this legislation strongly and urges its advancement as part of a total approach to turning the tide on PBM anti-competitive practices that force patients and others to pay more for their medicines, that limits patients’ access to their pharmacist, that restricts patients’ access to the medicines right for them, and that jeopardizes the pharmacies on which patients rely.”
Specifically, the bill prohibits “spread pricing” in Medicaid and establishes a “pass-through payment” model. It creates in Medicaid managed care a “rate floor” requirement similar to that of Medicaid fee-for-service that focuses on cost-based pharmacy reimbursement and dispensing fees.
NACDS notes that the legislation is consistent with key aspects of the Association’s broader Principles of PBM Reform. NACDS’ Principles of PBM reform include: stopping explosive retroactive fees; stopping below-cost reimbursement; stopping the gaming of performance measures; stopping “specialty definitions” from steering patients from their pharmacy; stopping mandatory mail-order; stopping limited networks; stopping overwhelming audits; and stopping the undercutting of “PBM” reform laws. NACDS is working at the federal and state levels to help inform policymakers about what is needed in the areas within their jurisdiction to bring about truly comprehensive and sustainable reform across all payer segments.
More information is available at an NACDS web page.
