U.S. Representative John Rose representing Tennessee’s 6th District recently joined three other House Members in introducing the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act. The legislation would improve options and access to prescription drugs for seniors, bring pharmacy benefit managers (PBMs) in alignment with Medicare plans, and ultimately allow seniors to shop at their local pharmacy.
The bill would also modernize Medicare and prevent PBMs from discriminating against pharmacies that are willing to contract with them, helping seniors to seek care closer to home. Under Medicare Part D, plan sponsors are required to (i) have standard terms and conditions that are “reasonable and relevant” and (ii) allow any pharmacy willing to accept the terms and conditions to participate in the sponsor’s network. This bill would explicitly ensure that PBMs are required to comply with this standard, bringing them in line with plan sponsors.
“Independent pharmacies are integral to the health care needs of rural communities in Tennessee and across the country,” said Rep. Rose. “We should protect them by holding PBMs accountable. I am proud to support this bipartisan, commonsense legislation on behalf of Tennessee’s independent pharmacists and patients.”
The NO PBMs Act is supported by the National Community Pharmacists Association, American Pharmacists Association, National Association of Specialty Pharmacy, and the American Pharmacy Cooperative, Inc.
“Every day across the country, pharmacy patients get letters from their PBMs telling them that they have to start using a PBM-owned pharmacy. Or they get a letter stating that their current pharmacy is no longer ‘preferred’ in the plan network,” said American Pharmacies President Laird Leavoy. “The letters often imply that scripts may no longer be filled at non-PBM pharmacies. It’s alarming and confusing to older patients, who out of fear often switch their business to the PBM’s pharmacy. Steering is a conflict of interest that decreases transparency and competition in the pharmacy services market. It drives up pharmacy care costs while harming patient care, especially in rural and medically underserved areas.