What Do the Midterms Mean for Pharmacy?

Editor’s note: By the time this issue is in readers’ hands, the 2022 midterm elections will have already been decided, but the issues discussed in this article—from drug pricing to PBM oversight—are still being addressed by elected leaders.

The 2022 midterm elections are poised to make a long-term impact on pharmacy: As Americans head to the polls, questions about drug pricing, pharmacy benefit managers (PBMs), and other issues hang in the balance. On Tuesday, November 8, 2022, the polls opened for US citizens to vote in the midterm elections. This year, all 435 seats in the House of Representatives, and 35 of the 100 seats in the Senate, were up for reelection¹—and the results of each race may have a major impact on independent pharmacies and the industry as a whole.

Erika Gray, PharmD, chief medical officer and cofounder of ToolBox Genomics in Walnut Creek, California, pointed out that pharmacists are most impacted when resources are removed or restricted. Common examples include states looking to restrict levonorgestrel (a hormone used for emergency contraception, also known as the “morning-after pill”) and pre-exposure or postexposure prophylaxis medications to prevent HIV infection. Although pharmacists are considered midlevel providers, many insurance programs—especially Medicare—are reluctant to reimburse pharmacists for their services or make reimbursement too cumbersome.

Important Issues

Independent pharmacies are affected by elections when candidates or incumbents elected representatives are supportive of or receive financial support from large chain pharmacies, typically under the guise of better prices for patients.

“Independent pharmacies cannot cover their overhead with medication reimbursement and have to rely on other services such as ordering labs, consultations, or compounded medications that are cash pay,” Gray said. “Any additional legislation that supports Amazon’s and other large chains’ expansion into mail order pharmacies will also adversely impact independent pharmacies.”

Aryana Sepassi, PharmD, assistant professor of clinical pharmacy at the University of California, Irvine School of Pharmacy and Pharmaceutical Sciences, said the midterm election results could have a significant impact on deciding who may advocate for improved regulations on PBMs.

“Independent pharmacies often struggle with losing patients due to PBMs entering into contracts with larger retail chain pharmacies,” she explained. “Of late, PBMs have really entered the political arena under scrutiny and are currently in consideration for new laws and provisions on regulation. Voters are concerned that PBMs aren’t translating cost savings to their patients. The election results are critical in giving patients a chance to vote for candidates who will continue to view PBMs [with] a critical eye for health policy.”

Another issue placing pharmacists front and center in the political arena is the ongoing discussion surrounding drug pricing. A huge piece of this stems from the drug pricing plan proposed by the Biden administration last year,² especially the notion of allowing Medicare to negotiate pricing for more expensive prescription drugs that individuals obtain through Medicare Part D and Part B. “This really opens the door to candidates to explore further methods in drug pricing negotiations,” Sepassi said. “For pharmacists, this means seeing your patients struggle less in getting the care they need, and perhaps a reduction in time to obtaining the right therapy.”

Tatyana Franklin, PharmD, founder and owner of Skin Rx-Pert LLC, noted that although members of Congress have stated their desire to reduce prescription medicine prices, they have struggled to deliver. “By enabling Medicare to negotiate lower medication prices, the Senate has a historic chance to [help] seniors afford the prescription pharmaceuticals they require,” she said. “State governments must also play a role, and several governors and state legislatures have already approved legislation establishing affordability review committees, boosting drug-price transparency, permitting safe drug importation, and limiting out-of-pocket expenses for particular prescriptions such as insulin.”

Bills in Play

Multiple pharmacy organizations are supporting bills that will help change provider status for pharmacists, allowing them to be reimbursed for certain services by Medicare Part B, specifically in medically underserved areas.

One bill is the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759).³ This bipartisan legislation will amend section 1861(s)(2) of the Social Security Act to include pharmacists as recognized health care providers. Another bill is the Equitable Community Access to Pharmacist Services Act (H.R. 7213),⁴ designed to establish pharmacist services more permanently for Medicare Part B beneficiaries as well as for possible medical emergencies.

“There are also several individual state bills around restricting PBMs and expanding pharmacist services,” Gray said, adding that passage or failure of these bills will come down to which party wins the most votes in the House and the Senate this year.

One bill Sepassi has her eye on is the Pharmacy Benefit Manager Transparency Act of 2022 (S. 4293).⁵ “If passed, it would empower the [Federal Trade Commission] to stop unfair and deceptive PBM business practices,” she said. “Specifically, it would encourage fair and transparent practices for PBMs with relation to pharmacies. This would be a huge step in regulating the PBM market in favor of independent pharmacies.”

Democrat or Republican?

“I think it’s difficult to say one political party has greater favor over another,” Gray said. “I think the perception is, certain parties stand for certain beliefs: [for example], Republicans are antiabortion; Democrats want Planned Parenthood. Depending on where a pharmacist falls on a particular ideology, [it] may push them toward one political party over another.” However, Sepassi believes the Democratic Party has historically been aligned with pharmacist issues, citing previous perspectives in favor of reducing drug pricing for patients and in mitigating the negative effects of PBMs on pharmacies.

Making a Difference

Frequently, pharmacists are the first of a patient’s health care providers to be alerted to a potential drug-drug interaction or a new or exacerbated medical condition. This, Gray explained, is why she would like to see more legislation leverage the accessibility of pharmacists. Such legislation would allow pharmacists to offer more services to patients, as either patient advocates or liaisons with their primary care providers to obtain more timely medical treatment.

Although Sepassi feels that Medicare for All is still far out of reach for Congress, the results of the midterms will be key in deciding whether the industry continues moving forward with improved regulations in drug pricing, negotiations, and PBMs. “[The] results of the elections will also hold considerable weight on other health care–related issues,” she said. “Improving telehealth access, value-based pricing models, and women’s reproductive rights are all up for debate this term.”

References

1. Zhou L, Narea N, Paz C. Your 2022 midterms cheat sheet. Vox. Published September 12, 2022. Accessed October 24, 2022. https://www.vox.com/policy-and-politics/2022/9/12/23344632/midterms-2022-elections-key-house-senate-races-control-congress 

2. President Biden announces prescription drug pricing plan in build back better framework. News release. The White House. November 2, 2021. Accessed October 24, 2022. https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/02/president-biden-announces-prescription-drug-pricing-plan-in-build-back-better-framework/ 

3. Pharmacy and Medically Underserved Areas Enhancement Act, HR 2759, 117th Cong (2021-2022). Accessed September 28, 2022. https://www.congress.gov/bill/117th-congress/house-bill/2759 

4. Equitable Community Access to Pharmacist Services Act, HR 7213, 117th Cong (2021-2022). Accessed September 28, 2022. https://www.congress.gov/bill/117th-congress/house-bill/7213 

5. Pharmacy Benefit Manager Transparency Act of 2022, S 4293, 117th Cong (2021-2022). Accessed September 28, 2022. https://www.congress.gov/bill/117th-congress/senate-bill/4293