Bipartisan Bill Aims to Reform Pharmacy Benefit Managers and Lower Drug Costs

On July 23, 2024, bipartisan lawmakers introduced the "Pharmacists Fight Back Act," targeting the practices of pharmacy benefit managers (PBMs) accused of inflating prescription drug prices. The legislation seeks to reduce healthcare costs for patients enrolled in federal programs like Medicare and Medicaid, while ensuring fair reimbursement for community pharmacies. The bill aims to empower patients with more choices regarding where to fill their prescriptions. Key executives from major PBMs, including UnitedHealth Group's Optum Rx, CVS Health's Caremark, and Cigna's Express Scripts, are set to testify amid growing federal scrutiny of their roles in escalating healthcare costs. The introduction of this bill aligns with ongoing bipartisan efforts at both federal and state levels to reform PBM practices, which have been criticized for retaining approximately $300 billion in revenue within the drug supply chain. Representative Auchincloss, a co-sponsor of the bill, emphasized that this legislation is "bigger and tougher" than previous efforts, focusing specifically on the reimbursement models for pharmacies. The proposed changes would center around the national average drug acquisition cost (NADAC), which reflects the average price pharmacies pay for medications. This new model is particularly relevant for generic drugs, aiming to enhance transparency and fairness in the pricing structure. The Federal Trade Commission is also reportedly preparing to take legal action against major PBMs, further highlighting the urgency of reform in the pharmaceutical supply chain. The "Pharmacists Fight Back Act" is being touted as the most comprehensive PBM reform initiative introduced at the federal level to date.