Pharmacy Groups Urge Congress to address Mounting PBM Crisis
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A coalition of leading pharmacy organizations is intensifying pressure on Congressional leaders to enact reforms targeting pharmacy benefit managers (PBMs), warning of a rapidly escalating crisis in patient access to medications and the closure of pharmacies nationwide.
A letter sent Friday to house Speaker Mike Johnson (R-New York) details the urgent need for legislative action to curb what the groups describe as harmful PBM practices.The organizations signing the letter include the National Association of Chain Drug Stores,the National Community Pharmacists Association,the Food Industry Association,the National Grocers Association,the American Pharmacists Association,and the National Association of Specialty Pharmacy.
PBMs Under Fire for Inflated Drug Prices and Market control
PBMs have faced increasing scrutiny in recent years due to their complex relationships with insurers and allegations of inflating drug prices. The industry is highly concentrated, with the top three PBMs – CVS Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx – collectively controlling approximately 80% of the prescription drug market.
Despite numerous attempts at reform, progress has been limited. A potential breakthrough in December 2024, when a spending bill with PBM crackdown provisions nearly passed, ultimately fell apart at the last minute. “As Congress’ near‑win on PBM reform in December 2024 – another missed opportunity that fell just short of enactment – the devastation of pharmacy access for patients and communities has only worsened,” the letter stated.
Pharmacy Closures Accelerate, Threatening Patient Access
The consequences of inaction are becoming increasingly visible.According to the coalition, pharmacies are now closing at an alarming rate of more than six per day, an acceleration from the nearly four-per-day closure rate observed in 2023 and 2024. Over the past year alone, more than 2,200 pharmacies have shuttered, resulting in a net loss of over 13% of pharmacies across the United States since January 2018.
“The failure to curb harmful PBM practices is no longer a crisis in the making – it now constitutes a crisis unaddressed,” the organizations wrote. “Without PBM reform, patients are experiencing inflated drug costs, and many no longer have access to the pharmacy of their choice as pharmacies close and others are pushed out of network.”
Specific Reforms Demanded by Pharmacy Groups
The coalition outlined several key reforms they believe are essential to address the crisis. These include:
- Medicaid managed care pharmacy payment reform and a ban on spread pricing, a practice where PBMs charge payers more than they reimburse pharmacies for medications, pocketing the difference as profit.
- Requiring the Centers for Medicare & medicaid Services (CMS) to define and enforce fair Medicare Part D contract terms and ensure genuine “any willing pharmacy” participation.
- Prohibiting PBM compensation in Medicare Part D from being tied to the list price of a drug.
- Promoting greater transparency in insurer claims and reimbursement practices provided to pharmacies.
“As Congress approaches key deadlines, we respectfully request that PBM reform be included in the next appropriate moving vehicle or advanced as a stand‑alone measure,” the organizations wrote. “The consensus is broad, the policy is developed, and the consequences of inaction are compounding.We stand ready to assist with swift enactment and implementation.”
Bipartisan Momentum Builds in the Senate
The call for reform comes on the heels of a bipartisan bill introduced in the Senate this month, the PBM Price Transparency and Accountability Act. This legislation aims to delink PBM compensation from negotiated rebates and increase reporting requirements for PBMs to Medicare Part D plan sponsors and the department of Health and Human Services (HHS).
The growing pressure from pharmacy organizations, coupled with bipartisan legislative efforts, signals a potential turning point in the fight for PBM reform, though the path to enactment remains uncertain.
