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Description

In this critical episode of the PBM Reform Podcast, we are joined by two influential voices leading the charge against abusive pharmacy benefit manager (PBM) practices:

• State Representative Jake Auchincloss – Congressman from Massachusetts’ Fourth District



• Greg Reybold – Vice President of Healthcare Policy & General Counsel, American Pharmacy Cooperative, Inc.

1. The "Pharmacists Fight Back Act" (HB 9096):
   
   
   
   • Legislation Overview:
     
     
     
     • The bill proposes a transparent pharmacy reimbursement model based on:
       
       
       • Market-based pricing benchmarked to the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee equivalent to each state’s Medicaid reimbursement or the lesser of 2% or $25.
       
       
       
       
     
     
     • Eliminating PBMs’ ability to restrict patient choice through network exclusions.

     
     
     • Ensuring rebate pass-throughs to patients directly at the pharmacy counter.

     
     
     • Prohibiting PBM practices that steer patients toward PBM-owned pharmacies, protecting community pharmacists and preserving patient choice.

     
     
     
     
   
   
   • Guest insights on how HB 9096 seeks to end exploitative PBM tactics and its potential impact on independent pharmacies nationwide.

   
   
   
   


2. The "Patients Before Monopolies Act":
   
   
   
   • Bipartisan Efforts:
     
     
     
     • Introduced by Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) to dismantle PBMs’ monopoly power.

     
     
     • Co-sponsored by Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN).
       
     
     
     
     
   
   
   • Key Goals:
     
     
     
     • Break up PBM ownership structures that lead to conflicts of interest.
     
     
     • Ensure fair reimbursement practices for all pharmacies, reducing patient drug costs and increasing healthcare access.
     
     
     
     
   
   
   • Discussion on the broader implications for federal programs and the pharmacy industry at large.

   
   
   
   


3. PBMs and Their Role in Driving Up Drug Costs:
   
   
   
   • Exploring how PBMs contribute to higher drug prices and diminished patient choice.
   
   
   • The detrimental effects of PBM practices on independent community pharmacies and patients enrolled in federal healthcare plans.

   
   
   
   

• Contact your legislators to express support for the Pharmacists Fight Back Act (HB 9096) and the Patients Before Monopolies Act.


• Share this episode to spread awareness of the critical need for PBM reform.

• Learn more about HB 9096 and its provisions: 
  
  
  
  • https://www.congress.gov/bill/118th-congress/house-bill/9096 
  
  
  
  


• Support the Patients Before Monopolies Act: 
  
  
  
  • https://www.drugtopics.com/view/long-awaited-pbm-reform-included-in-congress-end-of-year-spending-package 

  
  
  
  


• References: 
  Intro piece: "Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers" via CNBC Television