July 20, 2023

Manchin, Blackburn Introduce Bipartisan Legislation to Address PBMS, Improve Pharmacy Access

Washington, DC – Today, U.S. Senators Joe Manchin (D-WV) and Marsha Blackburn (R-TN) introduced the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act which would improve options and access to prescription drugs for seniors bringing pharmacy benefit managers or PBMs in alignment with Medicare plans, therefore, allowing seniors to shop at their local pharmacy. The bill would modernize Medicare and enhance PBM accountability by preventing them from discriminating against pharmacies that are willing to contract with them, helping seniors to seek care closer to home.

“It’s time to hold pharmacy middlemen accountable and put an end to their exploitative practices that have a harmful impact on patients’ – especially our seniors – access to and cost of prescription drugs,” said Senator Manchin. “This commonsense legislation will increase the accountability and transparency of PBMs to ensure small pharmacies can compete and patients can get a fair deal on the medications they need. Local and rural pharmacies are often the first line of care when it comes to getting life-saving medicines. It’s imperative that Medicare patients are able to access the pharmacies they know and trust. I encourage my colleagues on both sides of the aisle to support this bipartisan legislation that will lower prescription drug costs and put patients first.”

“Independent pharmacies can represent one of the primary points of care in rural and underserved communities. However, the current loopholes, that allow pharmacy benefit managers to circumvent the rules, limit a senior’s choice in care and make it difficult for independent pharmacies to keep their doors open. This bipartisan legislation will help put patients at the center and promote local pharmacies in Tennessee and across the nation,” said Senator Blackburn.

“Independent community pharmacies are under constant pressure from the anticompetitive tactics of drug middlemen. These vertically integrated PBMs, which are also direct competitors of independent pharmacies, offer take-it-or-leave-it contracts for Medicare Part D plans where the reimbursement rates are often below pharmacies’ cost to acquire and dispense drugs. These unfair contract terms leave pharmacies with the tough choice of either not participating in networks or continuing to serve seniors in their communities while losing money on these prescriptions filled and possibly going out of business. NCPA is thankful to Senators Manchin and Blackburn for this legislation to ensure CMS is conducting proper oversight of PBMs and that the contracts they offer are reasonable to allow pharmacies to participate in networks,” said Anne Cassity, Senior Vice President of Government Affairs at the National Community Pharmacists Association.

Under Medicare Part D, plan sponsors are required to (i) have standard terms and conditions that are “reasonable and relevant” and (ii)  allow any pharmacy willing to accept the terms and conditions to participate in the sponsor’s network. This bill would explicitly ensure that PBMs are required to comply with this standard, bringing them in line with plan sponsors. PBMs were created as third-party companies that function as intermediaries between insurance providers and pharmaceutical manufacturers. They create formularies, negotiate rebates with manufacturers, process claims, create pharmacy networks, review drug utilization and manage mail-order pharmacies. There are now just three PBMs that control approximately 89% of the market. Over time, PBMs have been allowed to operate virtually unchecked, leading to restricted access to care and higher costs of prescription drugs.

To read the full text of the legislation, please click here.