SCPC Applauds Senate Finance Committee for Near Unanimous Passage of PBM Reform Package
Swift passage of meaningful PBM reform must remain a priority for Congress in 2023
Washington, DC (July 27, 2023) – The Senior Care Pharmacy Coalition (SCPC), the leading national voice for the long-term care pharmacy community, applauds the Senate Finance Committee for its strong, bipartisan passage of the Modernizing and Ensuring PBM Accountability Act, sponsored by Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho).
This important pharmacy benefit manager (PBM) reform effort would address multiple well-known issues impacting both patients and pharmacies. The legislation advanced out of the committee yesterday with a 26-1 vote and now heads to the full Senate for consideration.
The package includes several priority reforms that the long-term care (LTC) pharmacy community has advocated for to increase transparency into PBM business practices while promoting better access to care and lowering costs for the millions of patients they serve every day across the country.
Several SCPC priorities specific to LTC pharmacies are included in the package along with broader reforms relevant to all pharmacies. Among the key elements of the bill are:
• Medicare Part D provisions requiring MedPAC to report publicly regarding the information PBMs disclose, including payment differentials between pharmacies affiliated with PBMs and unaffiliated pharmacies.
• Medicare Part D provisions requiring CMS to develop standardized quality measures by pharmacy type, including specific LTC pharmacy metrics, which all Part D Plans would have to use to evaluate pharmacy quality and adjust payments.
• Medicare Part D provisions requiring claims-level transparency and establishing a payment floor to cover based on pharmacy costs to acquire and dispense a covered drug to a plan enrollee.
• Medicaid provisions that would require Medicaid managed care plans to reimburse pharmacies based on average acquisition costs and the Medicaid fee-for-service dispensing fee.
Additionally, and perhaps most importantly for helping to address the cost of prescriptions, the bill would delink PBM compensation from the cost of medications. This would prevent PBMs from pocketing and profiting from ever-increasing list prices and rebates and require them to disclose why they classify certain medications as specialty drugs to prevent them from steering patients to PBM-affiliated specialty pharmacies.
“For too many years, PBMs have been allowed to force their heavy-handed, profit-driven tactics on patients and the pharmacies that serve them. Fortunately, our leaders in Congress are taking important steps to put patient health and access ahead of PBMs’ bottom lines,” said Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition. “On behalf of the long-term care pharmacy community, I commend Chairman Wyden, Ranking Member Crapo, and members of the Senate Finance Committee for their efforts to increase transparency and finally rein in the anti-competitive and unfair business practices of PBMs. Long-term care pharmacies across the U.S. stand behind them and are eager to see this important legislation passed in 2023.”
About Senior Care Pharmacy Coalition
The Senior Care Pharmacy Coalition (SCPC) is the only national organization exclusively representing the interests of LTC pharmacies, representing 75% of the sector overall. Its members operate in all 50 states and serve 850,000 patients daily in skilled nursing and assisted living facilities across the country. Visit seniorcarepharmacies.org to learn more.
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