NCPA, Biosimilar Forum Voice Support for PBM Reform Bill

On March 14, Ron Wyden (D-Ore), chair of the United States Senate Committee on Finance, and Mike Crapo (R-Idaho), ranking member of the Senate Committee on Finance, issued a letter renewing their call for bipartisan legislation addressing pharmacy benefit managers (PBMs), according to a press release. The letter was sent to the committee before a press conference which included pharmacy and patient advocates for PBM reform.¹

“Certain pharmacy benefit manager practices continue to jeopardize the viability and financial stability of pharmacies, forcing far too many to close up shop,” Crapo said in the press release. “Congress must pass our comprehensive, bipartisan legislation to reduce out-of-pocket medication costs for seniors, enhance federal oversight, and shore up patients’ access to the pharmacy of their choice.”¹

The letter reestablishes the senators’ commitment to their legislation that was introduced in Congress in 2023. The bipartisan package passed the Senate Finance Committee in 2023, according to the press release.¹ The Better Mental Health Care, Lower Drug Cost, and Extenders Act passed the committee 26-0 and the committee also voted 26-1 on the Modernizing and Ensuring PBM Accountability Act.^2,3

The Better Mental Health Care, Lower Drug Cost, and Extenders Act aims to expand mental health care and substance use disorder services under Medicaid and Medicare, as well as reduce prescription drug costs for seniors, extend Medicaid and Medicare provisions, and increase Medicare payments to support physicians and other providers.² The Modernizing and Ensuring PBM Accountability Act also aims to bring more transparency, accountability, and competition to PBM practices in the supply chain, according to a press release.⁴

As part of the press conference, members of the National Community Pharmacists Association (NCPA) attended to show their support of PBM reform. In a statement issued by NCPA, Douglas Hoey, CEO of NCPA, stated: “Most of our members serve what are considered vulnerable or highly vulnerable populations and are the only accessible health care providers in their areas. Small business pharmacies are the economic anchors of their communities, but they are being put on the endangered lists by PBMs. In 2023, 307 independent pharmacies closed their doors for good, which is about one pharmacy per day. Where will the next one be today? Even if one pharmacy per day dies at the hands of PBMs, many others are on life-support. This must be done and must be done this year.”⁵

In response to the press conference, Juliana Reed, MS, the executive director of the Biosimilars Forum, also weighed in on the impact that PBMs have on the biosimilar market. She said 3 PBMs control approximately 80% of the pharmacy benefit marketplace, saying that the Biosimilars Forum supposed the senators in urging congress to pass PBM reform.⁶

“The PBM monopoly blocks patients from having access to lower cost biosimilars. There is no better example than biosimilars for Humira, the world’s bestselling drug. Humira has risen 470% in price since first introduced. Ten Humira biosimilars have launched at prices up to 85% lower cost than the brand biologic. However, PBMs prioritize profits over patients and favor the higher-cost, high-rebate branded Humira biologic by placing it on a preferable formulary tier relative to its lower cost biosimilar alternatives,” Reed said in the statement. “It is time we put patients first.”⁶

References

1. Wyden, Crapo Call for Swift Passage of Bipartisan PBM Reforms. News release. United States Senate Committee on Finance. March 14, 2023. Accessed March 15, 2024. https://www.finance.senate.gov/chairmans-news/wyden-crapo-call-for-swift-passage-of-bipartisan-pbm-reforms

2. Wyden, Crapo Applaud Committee Passage of Legislation to Improve Mental Health Care, Lower Drug Costs and Extend Essential Medicaid and Medicare Programs. News release. November 8, 2023. Accessed March 15, 2024. https://www.finance.senate.gov/chairmans-news/wyden-crapo-applaud-committee-passage-of-legislation-to-improve-mental-health-care-lower-drug-costs-and-extend-essential-medicaid-and-medicare-programs

3. Wyden R, Crapo M. PBM Commitment Letter. March 14, 2024. Accessed March 15, 2024. https://ncpa.org/sites/default/files/2024-03/sfc-pbm-commitment-letter.pdf

4. Wyden and Crapo Introduce Finance Committee PBM Bill. News release. United States Senate Committee on Finance. September 28, 2023. Accessed March 15, 2024. https://www.finance.senate.gov/chairmans-news/wyden-and-crapo-introduce-finance-committee-pbm-bill

5. NCPA stands with bipartisan Senate Finance Committee at press conference. News release. NCPA. March 14, 2024. Accessed March 15, 2024. https://www.ncpa.org/newsroom/qam/2024/03/14/ncpa-stands-bipartisan-senate-finance-committee-press-conference

6. Biosimilars Forum Urges Congress to Support Free Market Competition and Lower Prescription Drug Prices for Patients by Reforming Pharmacy Benefit Managers. News release. March 14, 2024. Accessed March 15, 2024. https://biosimilarsforum.org/2024/03/14/biosimilars-forum-urges-congress-to-support-free-market-competition-and-lower-prescription-drug-prices-for-patients-by-reforming-pharmacy-benefit-managers/