WASHINGTON, D.C. – In an effort to lower drug costs and support small businesses, U.S. Senators Shelley Moore Capito (R-W.Va.) Jon Tester (D-Mont.), Sherrod Brown (D-Ohio), and James Lankford (R-Okla.) introduced legislation to hold Pharmacy Benefit Managers (PBMs) accountable.
The Protect Patient Access to Pharmacies Act will ensure that all pharmacy price concessions are assessed at the point of sale and eliminate the retroactive nature of direct and indirect remuneration (DIR) clawback fees imposed by PBMs. The Centers for Medicare and Medicaid Services (CMS) estimates this change will save Medicare beneficiaries an estimated $7.1 to $9.2 billion in reduced cost sharing.
“Pharmacists, including those in our small towns and rural areas, play a vital role in keeping our communities healthy,” Senator Capito said. “I’m proud to join my colleagues in introducing the Protect Patient Access to Pharmacies Act , which will help ensure pharmacies remain open and our Medicare patients will continue to have access to the medications and information they need from those they trust.”
BACKGROUND:
In recent years, PBMs have increasingly returned to pharmacies days or even weeks after the point-of-sale to demand more in DIR fees. From 2010 to 2019, CMS documented a 91,500% increase in DIR fees paid by pharmacies.
The Protect Patient Access to Pharmacies Act will increase transparency and hold PBMs accountable by:
• Enforcing and strengthening the federal “any willing pharmacy” law to ensure pharmacies are no longer subject to practices that ultimately limit network participation and steer patients away from pharmacies.
• Standardizing and overseeing the metrics PBMs and plans use to measure pharmacy performance and quality and ensuring they are fairly applied.
• Ensuring transparency in payments and fees issued by PBMs.
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