NACDS Highlights Outsized Role of Pharmacies

The NACDS 2023 Initiative, which the association launched last year, seeks to emphasize the role that pharmacies and retail stores play in health and wellness.

The focus is on health and wellness solutions throughout the store and through partnerships with other health care providers and community organizations. It was demonstrated last September at the White House Conference on Hunger, Nutrition, and Health, where NACDS held an event to call attention to the industry’s interest in these issues, said Chris Krese, senior VP of congressional relations and communications, NACDS.

“We’re really taking an aggressive position, and you’re going to be seeing more and more of this in 2023.”

PBM reform remains high on the agenda for pharmacy associations, as retailers seek to preserve the ability for patients to patronize their local retail pharmacy and to have greater visibility into the pricing practices of these entities.

NACDS describes the legislative and regulatory issues it is tackling as the “access agenda,” which Krese defines as patients’ “ability to get the convenient and equitable access to pharmacies that they expect.”

“There are a host of policy issues that affect that,” he said. “Certainly, an issue that tops the list is pharmacy benefit manager reform.”

The industry in the last few years has seen significant progress on PBM reform but is continuing to press for more reforms, particularly around transparency and pricing practices, Krese said, while the current political climate favors this type of legislative and regulatory action.

“Right now, there is significant interest at the federal and state level to address the issue, and that really flows from the recognition of how important it is to patients,” Krese continued. “There’s a real sense at this point that the PBM middlemen and those who hire them have gotten to the point that they’re manipulating the pharmaceutical benefit market to a degree that it’s impacting patients.”

He cited the unanimous U.S. Supreme Court decision of 2020, Rutledge v. Pharmaceutical Care Management Association, which paved the way for states to begin legislating on the issue of PBM reform themselves. Since then, there have been more than 100 new laws enacted at the state level around PBM reform, he said, and more efforts are in the works.

That decision was itself based on a state-level case in Arkansas in which the Pharmaceutical Care Management Association, which represents PBMs, had sued to prevent the state from forcing PBMs to reimburse pharmacies for prescription drugs at rate “equal to or higher than the pharmacy’s wholesale cost,” according to one description of the law.

That ruling, and another, PCMA v. Wehbi, created the opportunity for allowing states to exercise greater control over PBM practices, and several states have since followed suit, often in the interest of better managing their own Medicaid programs by increasing transparency.

Pennsylvania, for example, late last year expanded the ability for the state to audit PBMs that service the state’s Medicaid managed-care organizations.

These state actions often also serve retail pharmacies not only by increasing the transparency of PBM pricing practices but also by helping ensure that patients can continue to patronize their local pharmacist to receive their prescriptions.

New Jersey in October introduced S.B. 3199, which seeks to prohibit PBMs from steering patients to pharmacies that the PBM owns and prohibiting PBMs from charging a pharmacy a fee for network enrollment or collecting point-ofsale or retroactive fees from pharmacies. That bill has been referred to the state’s Senate Commerce Committee, according to law firm Mintz.

“We expect states to continue engaging in efforts to increase oversight of PBMs,” Mintz said in a recent blog post. “We will continue to monitor and report on relevant legislative activity.”

Independent Pharmacy’s Agenda

Retail pharmacy access also is a key focus of the National Community Pharmacists Association, said Anne Cassity, VP, federal and state government affairs at the association. “You saw how important patient access was, especially during COVID and the rollout of the vaccines,” she said.

PBMs have disrupted patient access to independent community pharmacies in particular, Cassity said. NCPA’s focus is to bring about changes in the pharmacy payment model that make it both more transparent and reflective of a drug’s actual acquisition cost. “You can’t operate any business if you’re getting paid below what you even acquired the product for — in this case, prescription medications,” she said.

One goal of the NCPA, Cassity said, is to reintroduce a bill called the Medicaid Managed Care Transparency Act, which was introduced in 2021 by Reps. Earl L. “Buddy” Carter (R-Ga.) and Vicente Gonzalez (D-Texas). The bill aims to prohibit “spread” pricing in all state Medicaid managed care programs and require that pharmacies be reimbursed at specific rate, such as the national average drug acquisition cost (NADAC), plus the state’s current fee-for-service dispensing fee.

“Prescription drug prices are way too high,” said Carter, a pharmacist himself, when he introduced the legislation. “With this bill, we can radically decrease drug prices and put power back into the hands of the patients.”

While NCPA would like to see PBM reform take place at the national level, the association has been working with individual state governments on the issue during the past several years. Cassity said there could be more activity in California this year around PBMs.

“They’ve done some really great reforms in Medicaid, but they struggled a little bit with PBM reforms,” she said.