Anne Cassity details the National Community Pharmacists Association's (NCPA's) next pharmacy benefit manager (PBM) reform priorities, focusing on fair pharmacy reimbursement and congressional scrutiny of health care consolidation and vertical integration.
In an interview with Pharmacy Times, Anne Cassity, senior vice president of government affairs at the National Community Pharmacists Association (NCPA), outlined the organization’s next phase of pharmacy benefit manager (PBM) reform efforts, emphasizing payment reform and addressing vertical integration as top priorities.
Cassity stated that although the recently
NCPA is advocating for a fair and transparent reimbursement model, including payment based on the National Average Drug Acquisition Cost (NADAC) plus a meaningful dispensing fee. Cassity explained that although the Centers for Medicare & Medicaid Services (CMS) already collects NADAC data, pharmacies often are not adequately reimbursed for their operational costs, including staffing, rent, and utilities. Because pharmacies cannot mark up medications beyond contracted rates, insufficient dispensing fees have become a leading contributor to pharmacy closures.
In addition to payment reform, Cassity highlighted concerns about consolidation and vertical integration in health care. She noted that insurance companies frequently own PBMs and affiliated pharmacies, creating potential conflicts of interest and anticompetitive practices. Bipartisan scrutiny in the US Congress, including recent hearings with major insurance executives, signals growing momentum to examine whether consolidation has reduced costs or improved access.
Cassity emphasized that pharmacists can support advocacy efforts at both the state and federal levels by engaging lawmakers, participating in regulatory processes, and elevating awareness about sustainable reimbursement and market competition. She characterized these efforts as critical to preserving patient access and ensuring the long-term viability of community pharmacy.
