BIRMINGHAM, Ala. (ABC 33/40) — A bipartisan bill moving through Congress is fueling a new debate between independent pharmacists and the pharmacy benefit manager industry over how pharmacies should be paid for filling prescriptions under a federal health insurance program.
Supporters of H.R. 6610, known as the Pharmacists Fight Back Act, say the legislation would help preserve community pharmacies by establishing fairer reimbursement standards for pharmacies participating in the Federal Employees Health Benefits (FEHB) Program, which provides health insurance to federal employees, retirees and their families.
The legislation would also require manufacturer rebates to be applied toward lowering prescription drug costs for patients, limit pharmacy benefit managers (PBMs) from steering patients to affiliated pharmacies they own or control, and establish penalties for violations.
PBMs act as intermediaries between health insurers, drug manufacturers and pharmacies. They negotiate prescription drug prices, manage pharmacy networks and determine how much pharmacies are reimbursed for dispensing medications.
Independent pharmacists have argued for years that some PBM reimbursement rates are so low that pharmacies lose money filling certain prescriptions.
“The thing that my pharmacist members want to do is take care of the people that come into their pharmacy,” said Bobby Giles, government affairs director for the Alabama Pharmacy Association. “That’s the number one thing they want to do. But you cannot do it at a loss.”
Giles said the legislation would allow more local pharmacies to participate in federal health plans while giving patients greater flexibility to use a pharmacy of their choice rather than being directed to mail-order services.
“You would have the opportunity to take care of those patients that you’re having to turn away right now,” Giles said. “There’s pharmacies all across Alabama—in Huntsville, in rural areas—that they can’t wait on a mail-order prescription for an acute medication of any kind.”
The Pharmaceutical Care Management Association (PCMA), which represents PBMs, strongly opposes the bill. In a statement, PCMA President and CEO David Marin called the legislation “a huge cash transfer from taxpayers to pharmacists and nothing more.”
Marin argued the proposal would increase the cost of providing health benefits to federal workers without improving patient care. “This bill does not help patients; it only puts taxpayers on the hook for a more expensive prescription drug benefit,” Marin said.
Giles rejected that criticism, arguing the legislation is intended to improve accountability and patient access rather than provide a financial windfall for pharmacies. “The PBMs that this company represents have been fleecing the U.S. government for years,” Giles said. “And now that they’re coming under scrutiny, they’re coming out.”
While H.R. 6610 applies specifically to the Federal Employees Health Benefits Program, Giles believes it could signal broader federal efforts to increase oversight of PBMs. “I think we’re headed in the right direction,” he said. “Transparency allows for accountability, and there’s been no transparency whatsoever in the PBM process.”
The House Committee on Oversight and Government Reform considered the legislation this week. The bill would still need approval from the full House and Senate before it could become law.
Below is the full statement from Marin on the committee activity:
“Let’s understand this bill for what it is: a huge cash transfer from taxpayers to pharmacists and nothing more. It makes providing health benefits to federal workers far more expensive, simply as a gift to one industry. Lawmakers must not be dragged around by the pharmacists’ lobby, which is working to create a more expensive prescription drug system that benefits them alone. This bill does not help patients; it only puts taxpayers on the hook for a more expensive prescription drug benefit. That is why many groups that rely on this program are sounding the alarm, including federal employee union organizations and those involved with the program. Lawmakers should take a much closer look at the consequences of such a pharmacist giveaway before moving any further with this bill or anything like it.”