 accused of inflating prescription drug prices, ensuring fair reimbursement for pharmacies and reducing healthcare costs for patients.){kind=link}
Bipartisan lawmakers have introduced the “Pharmacists Fight Back Act,” targeting the business practices of drug supply chain middlemen known as pharmacy benefit managers (PBMs). The bill seeks to ensure that community pharmacies can provide care to patients in federal health-care programs while being reimbursed fairly and transparently by PBMs. It aims to lower health-care costs for seniors covered by Medicare and Medicaid, government employees, and active-duty service members, among others, and offers more freedom in choosing pharmacies.
Reps. Jake Auchincloss (D-Mass.) and Diana Harshbarger (R-Tenn.) unveiled the bill before a House Oversight and Accountability Committee hearing on the tactics of drug middlemen. Executives from three major PBMs – UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts – are set to testify on allegations of contributing to rising healthcare costs amid increasing federal scrutiny.
The bill adds to numerous bipartisan efforts at both federal and state levels to reform PBMs, which negotiate drug manufacturer rebates on behalf of insurers, large employers, and federal health plans. These middlemen also create formularies of covered medications and reimburse pharmacies for prescriptions. However, lawmakers and drugmakers argue that PBMs overcharge the plans they negotiate for, underpay pharmacies, and fail to pass on discount savings to patients. Auchincloss highlighted that these practices have trapped $300 billion in revenue within the drug supply chain.
PBMs argue that drugmakers set high list prices for drugs and claim their tactics protect patients from high healthcare costs. Previous legislation targeting PBMs advanced through House and Senate committees with bipartisan support last year, but momentum stalled after Congress excluded PBM reform from a major government spending package.
The Biden administration has increased pressure on PBMs, with the Federal Trade Commission planning to sue Caremark, Express Scripts, and OptumRx. The new bill aims to increase transparency in PBM practices and ban spread pricing, where PBMs charge plans more than what they pay pharmacies for a drug. Auchincloss, co-leader of a previous PBM bill, described the new legislation as “bigger and tougher,” focusing on pharmacy support.
A key feature of the bill is a new pharmacy reimbursement model based on the national average drug acquisition cost (NADAC), ensuring drug prices reflect the actual cost to pharmacies. This model is particularly relevant to generic drugs. The current complex system involves multiple insurers, manufacturers, PBMs, and pharmacies, creating ambiguity around fees and markups.
The bill also mandates that PBMs share 80% of rebates with patients and prohibits several practices, including requiring branded medications when cheaper generics are available, steering patients to PBM-affiliated pharmacies, and excluding in-network pharmacies from filling prescriptions. Harshbarger stated that the bill aims to stop the exploitation of independent pharmacies, make life-saving drugs more affordable, and implement taxpayer savings solutions.
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