In a move that could potentially revolutionize the pharmaceutical industry, bipartisan lawmakers have introduced a new bill that targets the controversial business practices of drug supply chain middlemen. These middlemen, known as pharmacy benefit managers (PBMs), have long been accused of inflating prescription medication prices and adversely affecting both U.S. patients and pharmacies.
The Pharmacists Fight Back Act
The proposed legislation, dubbed the “Pharmacists Fight Back Act,” seeks to address the concerns of community pharmacies by ensuring fair and transparent reimbursement practices by PBMs. The bill aims to benefit seniors covered by Medicare and Medicaid, government employees, active duty service members, and other patients, by lowering healthcare costs and allowing greater freedom in choosing pharmacies for prescriptions.
Lawmakers and drug manufacturers have raised concerns about the monopolistic practices of PBMs, alleging that they overcharge plans, underpay pharmacies, and fail to pass on cost savings to patients. This has led to a significant revenue trap of $300 billion in the drug supply chain, ultimately affecting the affordability and accessibility of prescription drugs for Americans.
While previous bipartisan efforts to reform PBMs have made progress in Congress, recent legislative momentum has stalled, leaving critical issues unresolved. The Biden administration has increased pressure on PBMs, as the Federal Trade Commission plans to take legal action against major industry players such as Caremark, Express Scripts, and OptumRx.
Key Provisions of the Bill
The new bill builds upon earlier legislation by enhancing transparency around PBM practices, such as banning spread pricing and ensuring fair reimbursement based on a medication’s national average drug acquisition cost (NADAC). It also prohibits anti-competitive practices, such as steering patients to PBM-affiliated pharmacies and excluding independent pharmacies from filling prescriptions.
One of the main objectives of the bill is to protect independent pharmacies from being exploited and to make life-saving medications more affordable for patients. By requiring PBMs to share a higher percentage of rebates with patients and implementing other reforms, the bill aims to curb the excessive costs imposed on pharmacies and provide tangible savings to taxpayers.
The Pharmacists Fight Back Act represents a pivotal step in addressing the systemic issues within the drug supply chain industry and combating corporate greed. By advocating for greater transparency, fair reimbursement practices, and patient-centered reforms, lawmakers are striving to create a more equitable and accessible healthcare system for all Americans.