Representatives Krishnamoorthi, Carter, Dingell, and Rose Introduce Legislation Protecting Access to Local Pharmacies for Seniors

Washington, D.C. -This week, Reps. Raja Krishnamoorthi (D-IL), Earl “Buddy” Carter (R-GA), Debbie Dingell (D-MI), and John Rose (R-TN) introduced the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act, legislation which will require pharmacy benefit managers (PBMs) to align with Medicare plans for prescription drugs and will allow seniors better access and improved options. Many seniors across Illinois and the country rely on and prefer their local pharmacies to receive their prescription drugs, but, under current guidelines, PBMs can discriminate against certain pharmacies, driving up prices for seniors or forcing them to a different pharmacy against their wishes. This bill would build on calls for action by Rep. Krishnamoorthi for PBM accountability and would force them into Medicare compliance.

“We must hold pharmacy middlemen accountable by ending practices that steer patients away from their preferred community pharmacists while driving up their prescription drug prices. Our bipartisan legislation will close anti-competitive loopholes that PBMs use while ensuring small pharmacists are given reasonable contract terms to provide patients with fair prices on the medications they need,” Rep. Krishnamoorthi said.

“Seniors should be able to fill their prescriptions at the pharmacy that works best for them, not the PBM. Especially in rural areas, including Georgia’s First Congressional District, access to your local pharmacy is critical. I’m proud to lead this bipartisan bill, which will allow independent pharmacies to compete on a more level playing field and bring accountability to PBMs,” Rep. Carter said.

“All Americans, but especially seniors, should be able to conveniently access their necessary prescriptions. However, we too often hear about exploitative PBM practices complicating access to the pharmacies seniors depend on,” Rep. Dingell said. “Independent pharmacies are often an invaluable resource in underserved communities, and this legislation will ensure they can compete. Not only will it improve PBM accountability, but it will ensure seniors can get their medications closer to home and at the pharmacies they trust.”

“Independent pharmacies are integral to the health care needs of rural communities in Tennessee and across the country,” Rep. Rose said. “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.”

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.

U.S. Senators Joe Manchin (D-WV) and Marsha Blackburn (R-TN) introduced a companion bill in the senate.

“Independent community pharmacies are under constant pressure from the anticompetitive tactics of drug middlemen. These vertically integrated PBMs, which are also direct competitors of independent pharmacies, offer take-it-or-leave-it contracts for Medicare Part D plans where the reimbursement rates are often below pharmacies’ cost to acquire and dispense drugs. These unfair contract terms leave pharmacies with the tough choice of either not participating in networks or continuing to serve seniors in their communities while losing money on these prescriptions filled and possibly going out of business. NCPA is thankful to Representatives Carter and Krishnamoorthi for this legislation to ensure CMS is conducting proper oversight of PBMs and that the contracts they offer are reasonable to allow pharmacies to participate in networks,” Anne Cassity, Senior Vice President of Government Affairs at the National Community Pharmacists Association said.

“APhA supports Representative Buddy Carter’s (R-GA) introduction of the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act to ensure patients maintain access to their local pharmacy and their trusted, local community pharmacists,” Michael Baxter, Vice President of Federal Government Affairs at the American Pharmacists Association said.

“Specialty pharmacies manage patients with the most complex medical conditions including cancer, MS, rheumatoid arthritis, and organ transplants. This bill strives to ensure that patients have access to the specialty pharmacy of their choice to help manage and coordinate their care by addressing limited pharmacy networks that prohibit specialty pharmacy participation.  If a pharmacy can earn specialty pharmacy accreditation by meeting a national, independent accreditation organization’s specialty pharmacy standards, it should be able to participate in-network as a specialty pharmacy. NASP thanks the Congressman for his efforts to protect patient access to specialty pharmacies,” Sheila Arquette, President and CEO, National Association of Specialty Pharmacy (NASP) said.

“APCI is grateful to Congressman Carter for continuing to fight for patient choice,” American Pharmacy Cooperative, Inc. (APCI) CEO Tim Hamrick said. “This bill will help put a stop to PBMs from depriving patients of access to pharmacies through the use of network games and onerous terms and conditions.”

“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," American Pharmacies President Laird Leavoy said. “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. Rep. Carter's vital legislation would increase transparency into the relationships between insurers, PBMs and their affiliated pharmacies and protect the right of patients to use their pharmacy of choice.

Read the full bill text here.