Patients’ Pharmacy Access Relies on Fair Pharmacy Reimbursement

Background

Patients need reliable access to community pharmacies, which need fair reimbursement to stay in business. About 80 percent of drugs dispensed are generics, which pharmacists promote to help save beneficiaries and Medicare money.

Prices for many generic drugs are skyrocketing by 1,000% or more virtually overnight, yet drug plan middlemen known as pharmacy benefit managers (PBMs) may wait months to update reimbursement. That leaves independent community pharmacies with losses of $40 to $100 or more per prescription. Such losses are unsustainable any small business.

In addition, PBMs may be paying pharmacies low and charging much higher rates to health plans, including Medicare Part D drug plans. This practice of "spread pricing" was examined in a recent Fortune magazine article entitled "Painful Prescription."

Solutions

At the federal level, Congress should enact bipartisan legislation to do two things:

  1. Preserve patient access to pharmacies by ensuring their reimbursement from PBMs is updated more frequently to keep pace with actual market costs.
  2. Allow a pharmacy to know how its individual maximum allowable cost (MAC) reimbursement rates for multisource generic drugs would be determined (but not those of other pharmacies in that particular health plan's pharmacy network).

Reps. Doug Collins (R-Ga.) and Dave Loebsack (D-Iowa) have introduced H.R. 244, to implement these principles.

Sixteen states have enacted comparable legislation.

Take Action:

Consumers:

Urge your Members of Congress to support your pharmacy access by ensuring fair pharmacy reimbursement.

Pharmacists:

Engage your patients in the Fight4Rx grassroots advocacy network at www.fight4rx.org.

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