WCYB: Bipartisan bill reintroduced in congress aimed at reshaping pharmacy reimbursements

A bipartisan bill recently reintroduced in congress could reshape pharmacy reimbursements across the nation.

The legislation is filed around PBMs or Pharmacy Benefit Managers - these are the middlemen within the prescription drug supply chain. PBMs essentially negotiate pricing with drug manufacturers and secure reimbursements for pharmacies.

Lawmakers and healthcare leaders say, for years, these PBMs have been driving up drug costs and gouging community pharmacists.

The bill, as introduced in 2024 and again last week is called the 'Pharmacists Fight Back Act'; it's co-sponsored by Diana Harshbarger.

The goal is to prohibit PBMs from engaging in "predatory behaviors" by implementing a transparent pharmacy reimbursement model which would use market-based pricing.

Steve Hylton is the owner of Clark's Pharmacy in Saltville. He's also the president of the Virginia Community Pharmacy Association.

"A pharmacy will more profit from selling a candy bar than they do actually filling a life-saving medication for a month's supply for people," Hylton said. "I've seen a lot of prescriptions that we fill that we have to fill below the cost even to purchase the medication more or less the cost to dispense the medication, pay staff, rent and so forth."

Hylton also added, he's aware of a few stores in Southwest Virginia that have already closed and it's not just here.

According to lawmakers, on average, one independent pharmacy closes every day in the US.

This has garnered support from many with the federal bill receiving bipartisan support and non-partisan organizations like the American Economic Liberties Project, which is focused on disrupting "concentrated economic power".

Emma Freer is a senior policy analyst for healthcare.

"In healthcare you really can't find a better, or [in this case] worse example of concentrated economic power than in insurance conglomerates that own the three largest PBMs," Freer said.

According to Freer, United Health Group, Signa Group and CVS - all major insurers - own the three largest PBMs.

"With that vertical integration, not only are they monopolizing discrete markets like insurance and PBMs and pharmacies, but because they are vertically integrated, there are many opportunities for these conglomerates to drive prices up, to steer patients away from competitors including independent pharmacies, to prefer certain drugs over others that can interfere with patients access to medications they need," Freer said.

Freer says states across the nation, such as Ohio, Kentucky and West Virginia, have created their own similar legislation reforming the PBM system. Virginia has passed its own legislation to create a single PBM in the state, regulating reimbursements but, as announcement this week, the state is delaying the bills implementation by six months to January 1, 2027.