Patients Before Monopolies Act | PBM Reform Podcast

Pharmacy Podcast Network

In this critical episode of the PBM Reform Podcast, we are joined by two influential voices leading the charge against abusive pharmacy benefit manager (PBM) practices:

• State Representative Jake Auchincloss – Congressman from Massachusetts’ Fourth District
  
• Greg Reybold – Vice President of Healthcare Policy & General Counsel, American Pharmacy Cooperative, Inc.

Topics Discussed:

1. The "Pharmacists Fight Back Act" (HB 9096):
   • Legislation Overview:
     • The bill proposes a transparent pharmacy reimbursement model based on:
       
       • Market-based pricing benchmarked to the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee equivalent to each state’s Medicaid reimbursement or the lesser of 2% or $25.
     • Eliminating PBMs’ ability to restrict patient choice through network exclusions.
       
     • Ensuring rebate pass-throughs to patients directly at the pharmacy counter.
       
     • Prohibiting PBM practices that steer patients toward PBM-owned pharmacies, protecting community pharmacists and preserving patient choice.
       
   • Guest insights on how HB 9096 seeks to end exploitative PBM tactics and its potential impact on independent pharmacies nationwide.
     
2. The "Patients Before Monopolies Act":
   • Bipartisan Efforts:
     • Introduced by Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) to dismantle PBMs’ monopoly power.
       
     • Co-sponsored by Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN).
       
   • Key Goals:
     • Break up PBM ownership structures that lead to conflicts of interest.
     • Ensure fair reimbursement practices for all pharmacies, reducing patient drug costs and increasing healthcare access.
   • Discussion on the broader implications for federal programs and the pharmacy industry at large.
     
3. PBMs and Their Role in Driving Up Drug Costs:
   • Exploring how PBMs contribute to higher drug prices and diminished patient choice.
   • The detrimental effects of PBM practices on independent community pharmacies and patients enrolled in federal healthcare plans.
     

Call to Action:

• Contact your legislators to express support for the Pharmacists Fight Back Act (HB 9096) and the Patients Before Monopolies Act.
• Share this episode to spread awareness of the critical need for PBM reform.

Resources & Links:

• Learn more about HB 9096 and its provisions:
  • https://www.congress.gov/bill/118th-congress/house-bill/9096
• Support the Patients Before Monopolies Act:
  • https://www.drugtopics.com/view/long-awaited-pbm-reform-included-in-congress-end-of-year-spending-package
    
• References:
  Intro piece: "Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers" via CNBC Television