Federal
From the FTC, to the halls of Congress, to reports from 3 Axis Advisors and white papers from APCI, the unscrupulous practices of large PBMs were exposed like never before in 2024, and the legislative climate and momentum for reform of PBM practices reached a fever pitch.
Reforms on the table included transparency reporting and Representative Buddy Carter’s Medicaid managed care reforms — reimbursement at NADAC +, spread pricing ban, and mandatory NADAC reporting — included in the Lower Costs, More Transparency Act; revisions in Medicare Part D including delinking, transparency reporting, and reasonable and relevant contract terms for independent pharmacies; as well as delinking and transparency in the commercial market. These solutions were on the table and thought to be in the year-end package before ultimately becoming a casualty in the eleventh hour. APCI supported the reforms to be included in the year-end package but also maintained they did not go far enough to protect independent pharmacies and their patients. Even if those reforms had passed, that would have been the beginning and not the end of PBM reform.
Enter the Pharmacists Fight Back Act (PFBA, H.R. 9096), introduced by Representatives Jake Auchincloss and Diana Harshbarger in July, the same day as a House Oversight hearing on the issue.
View the House Oversight hearing on PBM transparency and accountability
APCI was proud to collaborate on this legislation, which looked to address PBM abuses in large federal healthcare plans — Medicare Part D, Medicare Advantage, Medicaid managed care, Tricare, and the Federal Employees Health Benefits Program — including without limitation:
- Taking away the ability of PBMs to set and manipulate drug prices;
- Requiring pharmacy reimbursement to be based on a NADAC + model;
- Prohibiting patient steering;
- Prohibiting several PBM practices including point-of-sale and retroactive fees, brand mandates, spread pricing, and tying reimbursement of a drug to outcomes, scores, or metrics;
- Requiring rebates to be shared with patients at the counter; and
- Imposing criminal penalties for PBM violations.
APCI focused significant effort on obtaining cosponsors for PFBA and laying the groundwork for the solutions proposed in PFBA to be on the table for 2025. APCI’s effort included working closely with PUTT and several state associations and other groups to establish a grassroots effort in reaching 50 cosponsors for PFBA by Thanksgiving. This goal was achieved, and the year ended with a total of 56 Representatives signed on to the legislation.
Alabama, Massachusetts, and Texas led the pack with four cosponsors each, with Kentucky, Tennessee, and Georgia boasting three cosponsors. Garnering this level of support shattered any notion that there is not an appetite for protecting independent pharmacy or for aggressive PBM reform.
Read below for highlights of APCI’s efforts in connection with the PFBA and other advocacy initiatives.
July 2024: PUTT Summit
On the heels of PFBA’s introduction, APCI’s Greg Reybold joined Rep. Auchincloss for a conversation with PUTT members regarding the PFBA. Representative Auchincloss stated he has an ambitious goal of 50 cosponsors by Thanksgiving.
Sept. 19, 2024: PFBA Press Conference
APCI’s Cathy Hanna and Greg Reybold were joined by several APCI members, including APCI Board member Ron Poole and APCI members AJ Patel and Vic Johnson; PUTT CEO Monique Whitney; PUTT Executive Committee Board members Lauren Young and Brandi Chane; Kentucky Pharmacy Association CEO Ben Mudd; Tennessee Pharmacists Association CEO Anthony Pudlo; patient advocate Loretta Boesing; and several other pharmacists at a press conference in support of PFBA.
APCI was grateful for the Representatives who showed up and spoke in support of the PFBA:
- Representative Jake Auchincloss
- Representative Diana Harshbarger
- Representative Nikki Budzinski
- Representative Sanford Bishop
- Representative Ralph Norman
September 2024: Business of Pharmacy Podcast
APCI’s Greg Reybold talked PFBA with Mike Koelzer on the Business of Pharmacy Podcast.
Listen to the Business of Pharmacy Podcast episode
September 2024: PUTTcast
APCI’s Greg Reybold joined Representative Auchincloss on the PUTTcast with Pharmacists United for Truth and Transparency’s (PUTT) Executive Director Monique Whitney and PUTT Board member Lauren Young to discuss the PFBA.
Listen to the PUTTcast episode
November 2024: APCI Post-Election Drug Pricing Forum
The week after the election, APCI sponsored a drug pricing forum on Capitol Hill which educated health staffers on the PBM reform landscape with an emphasis on the PFBA. This forum featured drug pricing leaders Representative Auchincloss and House Oversight Chair Representative Comer. It also featured a panel moderated by APCI’s Greg Reybold with PUTT Executive Director Monique Whitney, Economic Liberties Project Senior Policy Analyst for Healthcare Emma Freer, and Dr. Marion Mass.
December 2024: PBM Reform Podcast
APCI’s Greg Reybold joined Representative Auchincloss for a conversation with Todd Eury regarding the PFBA and the Patients Before Monopolies Act.
Listen to the PBM Reform Podcast episode
States
APCI remains active in member states and beyond, supporting advocacy efforts through policy and political guidance, legislative drafting and review, and offering presentations and testimony.
September 2024: Mississippi PBM Forum
APCI’s Bill Eley and Greg Reybold participated in an educational event organized by the Mississippi Independent Pharmacy Association which was well attended by state legislators, regulators, and employers. Speakers included Antonio Ciaccia of 3 Axis Advisors; Greg Baker, the CEO of AffirmedRx; and Greg Reybold.
October 2024: Georgia Hearing on PBM Landscape at Capitol
APCI’s Greg Reybold presented to members of the Georgia General Assembly on unfair practices of large PBMs.
November 2024: Alabama Luncheon
APCI and the Alabama Pharmacy Association hosted a PBM educational event for invited members of the Alabama General Assembly. Speakers included APCI’s CEO Tim Hamrick, APCI’s Greg Reybold, APA’s Bobby Giles, and APCI member Johnny Brooklere.
November 2024: Comments to Arkansas Commissioner of Insurance
APCI offered written comments in connection with the Commissioner of Insurance’s proposed rule regarding fair and reasonable reimbursement to independent pharmacies. APCI’s Greg Reybold provided comments in support of the proposed rule along with technical comments to ensure the rule was as strong as possible.
APCI Insights
APCI continues to shape drug pricing policy via expert input, testimony, and, now, a white paper series aptly named “APCI Insights.” In the two most recent white papers, disparate treatment between independent pharmacies and mail-order pharmacies, and chain pharmacies are explored. Read them here: