PBM Reform Podcast

Patients Before Monopolies Act | PBM Reform Podcast

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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.
    • Topics Discussed:
    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.

          • 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.

                • 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.

                    • Call to Action:
                    • 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.
                      • Resources & Links:
                      • 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 
                            ...more
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                            PBM Reform PodcastBy Pharmacy Podcast Network
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