Tag: Pharmacy Benefit Managers (PBMs)
PBM reform legislation reintroduced
July 10, 2025HME News Staff
ALEXANDRIA, Va. – A dozen lawmakers have introduced a comprehensive pharmacy benefit manager reform package in the House of Representatives.
The “PBM Reform Act” includes all the reforms that were included, but did not pass, in the original continuing resolution package from December 2024:
The “Drug Price Transparency in Medicaid Act,” which bans spread pricing in Medicaid and ensures pharmacies are fairly and adequately reimbursed for serving...
NCPA supports provision in budget bill
May 27, 2025HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association applauds the passage of a budget reconciliation bill in the House of Representatives that includes language that would eliminate pharmacy benefit manager spread pricing. It also would require transparent and fair reimbursement (Medicaid fee-for-service) in all state Medicaid managed care programs. “While doing nothing to reduce the cost of drugs for Medicaid beneficiaries, spread pricing has been costing federal and state...
NCPA presses Congress on PBM reform during fly-in
May 5, 2025HME News Staff
ALEXANDRIA, Va. – Hundreds of independent community pharmacy advocates from 39 states and the District of Columbia went to Capitol Hill April 30-May 1 as part of the National Community Pharmacists Association’s Congressional Pharmacy Fly-In. Attendees visited more than 280 congressional offices to discuss why Congress must act swiftly to finalize and pass pharmacy benefit manager reform legislation and push the CMS to correct course on Medicare Drug Price Negotiation Program implementation....
Alabama passes PBM reform bill
April 10, 2025HME News Staff
BIRMINGHAM, Ala. – The Alabama House of Representatives has unanimously passed SB252, a bill that would support independent pharmacies statewide by creating more transparency and limiting the power of pharmacy benefit managers. The “Community Pharmacy Relief Act,” which was already approved by the Senate on March 20, was introduced by Sen. Billy Beasley, D-Clayton, and Rep. Phillip Rigsby, R-Huntsville, a pharmacist. Rigsby told the Alabama Political Reporter that the bill addresses...
Optum Rx says it’s looking to ‘correct imbalances’
March 24, 2025HME News Staff
EDEN PRAIRIE, Minn. – Optum Rx will align payment models more closely to the costs pharmacies may face due to manufacturing pricing actions effective immediately and with full implementation by January 2028.
The company says the change will positively impact its non-affiliated network pharmacies, including the more than 24,000 independent, community pharmacies it serves.
“Pharmacies and pharmacists provide important care to patients, and we recognize that increasing...
Senators move to protect indie pharmacies
March 13, 2025HME News Staff
WASHINGTON – Sen. Peter Welch, D-Vt., along with Sens. Roger Marshal, R-Kan., Mark Warner, D-Va., and Bill Cassidy, R-La., has introduced legislation to limit what they say are abusive pricing practices by pharmacy benefit managers.
The “Protecting Pharmacies in Medicaid Act” cracks down on what they call “spread pricing” - charging Medicaid more than PBMs charge pharmacies for a drug, driving up costs for Medicaid and short-changing pharmacies. The legislation...
Indie pharmacy hosts FTC chair
March 10, 2025HME News Staff
REMINGTON, Va. – Al Roberts and Travis Hale, the owners of Remington Drug Company in Remington, Va., hosted Andrew Ferguson, chair of the Federal Trade Commission, to illustrate the challenges posed by pharmacy benefit managers and emphasize the significant role independent pharmacies play in their communities.
Also present: B. Douglas Hoey, pharmacist, CEO of the National Community Pharmacists Association; Matthew Seiler, general counsel for NCPA; and Anne Cassity, senior vice president...
Former NCPA president urges action on PBM reform
February 27, 2025HME News Staff
WASHINGTON - Hugh Chancy, former president of the National Community Pharmacists Association and a co-owner of Chancy Drugs in Georgia, urged members of Congress to take immediate action and pass common-sense pharmacy benefit manager reforms during a recent House Energy and Commerce Subcommittee on Health hearing that examined PBM reform policies. Emphasizing the important role of pharmacies like his in providing essential health care services to patients, he said this work is jeopardized by the...
NCPA joins price-fixing lawsuit
January 27, 2025HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association has joined a class action lawsuit against GoodRx, as well as CVS Caremark, Express Scripts, MedImpact Healthcare Systems and Navitus Health Solutions, that accuses them of colluding in a scheme to fix reimbursement rates to independent pharmacies. The lawsuit, brought by Community Care Rx, an independent pharmacy in Michigan, alleges that GoodRx and several PBMs are violating federal antitrust law by sharing competitively sensitive...
In brief: FTC scrutinizes PBMs – again, Lincare settles, Cardinal breaks ground
January 17, 2025HME News Staff
WASHINGTON – The Federal Trade Commission has published a report that found pharmacy benefit managers Caremark Rx LLC (CVS), Express Scripts and OptumRx marked up numerous specialty generic drugs by hundreds or thousands of percent.
The report, the second produced by the FTC, focused on PBMs influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV and a variety of other critical drugs.
“The FTC staff’s second interim...