New legislation signed by Governor Ned Lamont has brought cause for celebration among Connecticut pharmacists and patients alike in the fight for drug pricing transparency. House Bill 7363, now Public Act 19-199, was signed on July 12 and will go into effect on January 1, 2020.

The legislation places major restrictions on pharmacy benefit manager (PBM) clawbacks, or the results of an insurance company assigning expensive copays to a drug leading to a significantly higher price than the value of that drug, along with direct and indirect remuneration (DIR) fees. Furthermore, it prohibits PBMs and insurance companies from forcing pharmacies to pay back any part of a claim that the PBM or insurance company has already paid.

"Clawbacks and DIR fees have driven dozens of Connecticut pharmacies out of business," said Nathan Tinker, CEO of the Connecticut Pharmacists Association, in a prepared statement. "Public Act 19-199 will help to protect pharmacies from predatory practices that kill community pharmacies and drive consumer prices up. But it is just a first step in one state--federal legislators must act nationally to eliminate DIR across the industry and create transparency for patients and consumers."

ACPA has joined nearly 3,500 pharmacists and 170 patients to support comprehensive DIR reform, which would eliminate the retroactive nature of DIR fees and create fairness and transparency for community pharmacists and their patients.

Recently, the Centers for Medicare and Medicaid Services (CMS) final drug pricing rule failed to reform DIR fees. Between 2010 and 2017, DIR fees on pharmacies participating in Medicare Part D grew by 45,000%, according to the organization. CMS also estimated=s that DIR reforms would have saved Medicare beneficiaries between $7.1 and $9.2 billion in cost sharing over the next 10 years.

“The fight is not over for PBM reform,” said Tinker. “CPA stands behind over 200 pharmacy stakeholder and patient advocacy groups in their call for the U.S. Senate Finance Committee to include the elimination of DIR fees in its drug pricing legislation.”


CT Pharmacists Win Major PBM Clawback Battle, But the Fight Continues [press release]. CPA website. Accessed July 16, 2019.