HARRISBURG, PA — In a united front that transcends political divides, over one hundred pharmacists and pharmacy students gathered with state legislators in Harrisburg on Monday to advocate for crucial reforms to the operations of Pharmacy Benefit Managers (PBMs) in Pennsylvania. The rallying cry for change comes in support of Senate Bill 1000 and House Bill 1993, legislation aimed at curbing what many see as predatory practices by PBMs that threaten local pharmacies and inflate prescription drug costs.
Governor Josh Shapiro has thrown his weight behind the push for PBM reform, highlighting it as a priority in his recent state budget address with a call for #PBMReformNow. Despite PBMs’ role in negotiating drug prices through Medicaid, critics argue that the savings they secure are not passed down to insurers or pharmacies but rather pocketed by the PBMs themselves. This model has placed a financial strain on local pharmacies, evidenced by Mainline Pharmacy’s announcement in January of its decision to close nine locations after losing $350,000 in six weeks due to inadequate reimbursements from PBMs.
The closure of Mainline Pharmacy’s locations is not an isolated incident. Since January, more than 70 chain and independent pharmacies have shuttered across Pennsylvania, a trend that underscores the broader impact of current PBM practices on community access to healthcare services.
Chris Antypas, a local pharmacy owner and president of the Pennsylvania Pharmacists Association, emphasized the urgency of the situation, stating, “The timing is perfect to take steps to create a transparent and accountable PBM system that will lower prescription drug costs and protect access to pharmacies for Pennsylvania taxpayers.” With strong bipartisan support within the legislature, Antypas and his colleagues believe now is the time to end what they describe as the unchecked flow of taxpayer money to PBMs.
The proposed legislation aims to address several key issues:
- Ensuring pharmacies receive reimbursement that covers the cost of purchasing and dispensing medications.
- Eliminating “spread pricing,” a practice where PBMs charge health plans more for medications than they pay pharmacies, keeping the difference as profit.
- Stopping “patient steering,” which forces patients to use PBM-owned pharmacies or face higher out-of-pocket expenses.
- Empowering the Department of Insurance to audit PBM contracts with pharmacies.
- Establishing a process for pharmacies to lodge complaints about PBMs and seek resolutions.
Victoria E. Elliott, R.Ph., MBA, CAE, chief executive officer of the Pennsylvania Pharmacists Association, expressed gratitude toward Governor Shapiro and the bills’ sponsors for their leadership and commitment to reform. “We need to stop mass closures of pharmacies that have become an integral part of local communities across the commonwealth,” Elliott remarked. “Passing #PBMReformNow will preserve community pharmacies as viable local businesses and restore patients’ choice of their preferred pharmacy provider.”
As Pennsylvania’s annual Medicaid spend on the pharmacy benefit has surged from $1.41 billion in 2013 to $3.7 billion, according to the National Community Pharmacy Association (NCPA), the stakes for reform have never been higher. Advocates argue that without immediate action, the continued rise in prescription costs and the erosion of community-based healthcare services will only worsen.
With bipartisan support in both the Senate and House, Pennsylvania stands at a crossroads. The outcome of the legislative push for #PBMReformNow could set a precedent for how states across the nation tackle the complex challenge of ensuring affordable access to prescription medications while preserving the vital role of local pharmacies in community health.
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