The American Pharmacists Association is dedicating further time and resources to its ongoing fight for federal PBM reform.
Amidst ongoing tensions between the 3 biggest pharmacy benefit managers (PBMs) and pharmacy advocacy groups nationwide, the American Pharmacists Association (APhA) launched a new campaign late last week titled “End PBMs NOW.” Touted as a consumer-focused campaign, the organization is tapping into its members and affiliates to pressure Congressmen on the Hill and act against scrutinized PBM practices.
“This campaign, aptly named End Harmful Practices of PBMs Now, brings to light the truth behind PBMs and the direct effect they have on pharmacy store closures across the country. It paints a bleak picture for the future of our profession and the quality of patient care if PBMs are allowed to continue their abuses,” wrote APhA in a news release.1
Although PBMs and their role within the pharmaceutical supply chain date back to the late 1950s,2 it’s only within the past few years that the general public has shifted its focus toward PBMs, specifically those known within the industry as the “Big 3”—CVS Caremark, Express Scripts, and Optum Rx, owned by CVS, Cigna, and UnitedHealth Group respectively. After years of vertical integration within the market, these 3 PBMs have taken over about 80% of the pharmacy benefits market.3
These companies’ have exhibited the ability to consolidate market share with the help of common business practices that benefit PBMs and the manufacturers they work with but damage the revenue streams and reimbursement accessibility for independent pharmacies not affiliated with one of the 3 major PBMs or their chain drug stores.
Despite most of the industry, independent pharmacists especially, showing their distain toward PBMs over the years, movement for federal PBM reform is slowly becoming more and more realistic for the pharmacists and organizations who’ve been advocating for it.
The American Pharmacists Association building in Washington, D.C. | image credit: emkaplin / stock.adobe.com
PBMs have been vertically integrating and growing in size and revenue for what seems like a vast majority of the 21st century and prior. However, sentiments began rapidly changing after the Federal Trade Commission launched its investigation into major PBMs in 2022; the investigation is ongoing and the organization has since released its interim report on the 6 largest PBMs rather than just the 3 largest.1,4
Finally, aside from the FTC’s work to uncover the practices of each of the 6 biggest PBMs, there are 3 PBM reform bills that APhA is focusing on within its mission regarding End PBMs NOW. Those bills include S. 2973/H.R. 5378, the Modernizing and Ensuring PBM Accountability (MEPA) Act; S. 3430, Better Mental Health Care, Lower-Cost Drugs, and Extenders Act; and S. 127, the Pharmacy Benefit Manager Transparency Act.5
READ MORE: How PBMs Impact Independent Pharmacies
When visiting APhA’s official End PBMs Now website, users will have an opportunity to learn more about PBMs and their role as pharmaceutical “middlemen” within the supply chain. Furthermore, visitors will have the chance to learn more about the aforementioned legislation currently making its way through Congress.
Serving as a one-stop-shop for general citizens to learn more about PBMs and ultimately take action themselves, the website offers users an email template with a detailed message and subject line directed at Senators Cory Booker (D-NJ) and Robert Menendez (D-NJ) as well as New Jersey State Representative Bonnie Watson Coleman (D).
“As a healthcare provider and your constituent, I am asking you to support the passage of federal PBM reform this Congress to combat PBMs’ unfair business practices to keep community pharmacies’ lights on for the patients we serve in our state,” reads an excerpt of APhA’s message to the New Jersey Congresspeople.5 “The powerful PBM lobby is fiercely opposing this crucial legislation, which aims to address the unregulated PBM industry that is driving up drug costs and creating accessibility issues in rural and underserved areas. We need your support to pass PBM reform without delay!”
When it comes to current legislation being deliberated upon in Congress, there is still a long road ahead for a national change to the way PBMs operate as most of the proposed bills will not take effect until 2026; and all of that is reliant on these bills eventually being passed on the floor.5
With its conveniently designed email platform, visitors will be able to pledge their alliance with APhA and give US senators with the power to invoke change a push to fix issues within the pharmaceutical supply chain.
“Thank you for your continued support for our state’s pharmacists and our patients. Few issues have garnered as broad bipartisan consensus in Congress as PBM reform. Please support the inclusion of these bills in an end-of-year healthcare package in this Congress to protect our patients’ access to their trusted community pharmacists,” concluded the pre-planned message toward the New Jersey Congresspeople.5
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