Pharmacy Benefit Managersby Representative Doug Collins
Posted on 2015-12-08
COLLINS of Georgia. Mr. Speaker, I come here today, as I have on
many other occasions, to discuss an issue that is close to my heart,
but it is also close to every small community and every large community
across the country, and that is the plight of our community
pharmacists. Community pharmacists are struggling to survive each and
every day in light of the anticompetitive behavior of pharmacy benefit
Let me state up front: I have no problem with a company doing business. I have no problem with them playing in the bounds of what is fair and what is legal, and PBMs have a role in the marketplace. However, what we found out just in the last few weeks in the Judiciary Committee in a hearing is there is still a lack of regulation, enforcement, and transparency, and it is threatening the very existence of our community pharmacists in which the PBMs are acting not as competitors but, many times, as bullies.
To make matters even worse--and this is what was amazing to me-- community pharmacists cannot even speak out about the appalling practices of the PBMs that they are forced to do business with because, when they do, the repercussions are swift and severe. It has been amazing to me to talk all across the country to community pharmacists who simply want to talk about what is going on in their business model in which they are put at a distinct disadvantage, and yet there are many of them saying: I can't say anything publicly because I know I will be reprimanded or my contract will be changed or my contract will be withdrawn, and I will be out of business.
Mr. Speaker, that is just wrong. No matter what is said, we have seen firsthand that in relation to State laws that have been in response to this issue, the States have enacted transparency reform with generic drug prices and reimbursement systems called the MAC transparency laws.
In fact, to date, 24 States have enacted such laws. The goals of these laws is to increase transparency and provide structure around the generic drug pricing and reimbursement system. But when community pharmacists speak out in support of these reasonable reforms, the PBM community has retaliated through business lawsuits against the State and even discussing it in the contracts with community pharmacists saying: Well, it would be better if we get these laws repealed.
There is just a problem here. When you have the ability to force your competitors to be audited by you and to be controlled by you to where there is no transparency, where there are issues of community pharmacists simply barely able to survive, the PBMs are not representing the best interests of consumers; the PBMs are representing themselves. If they were truly acting in the best interest of consumers, as they claim, they would not oppose virtually every single transparency reform effort on the State and the Federal level. In fact, it is really interesting. They come to Congress and say one thing to Members, and then they turn around and behave however they wish in the pharmacy marketplace without fear of enforcement or oversight.
As I said from this floor a few weeks ago, I will continue this fight because they can't audit me. They can audit my community pharmacists, and my community pharmacists are scared because they know their very livelihood is being put out by those who would come with shiny objects and savings that many times never materialize, but at the same time funneling money to their own businesses.
Mr. Speaker, it is time to change, and it is time to change it now. We must preserve pharmacy access for patients, especially those in rural areas like north Georgia, and we must put an end to the bullying that seems to be going on.
What is amazing is a PBM can make a mistake and say that a pharmacy was not part of the new network, and when called on that, saying that we are part of that new network, they say: Well, we will send out a retraction when we get around to it. Pharmacists lose business based on these kinds of letters, and, yet the PBMs say: Oh, well, we will get around to it when we can.
That is why I am proposing H.R. 244, because community pharmacists routinely incur losses of approximately $100 or more on prescriptions because PBMs reimburse pharmacies well below their cost to acquire and dispense generic prescription drugs, and they have skyrocketed in price. The PBMs may wait weeks or months to update the reimbursement benchmarks they use to compensate pharmacies while drug prices increase virtually overnight. This situation jeopardizes pharmacists' ability to continue to serve patients because it leaves community pharmacists with unsustainable losses.
Mr. Speaker, I would urge you and other colleagues to cosponsor H.R. 244. This reasonable legislation would require PBMs to update their maximum allowable cost benchmark every 7 days to better reflect market costs and allow pharmacists to know the source by which PBMs set reimbursements for their community pharmacist.
Many times we come to the floor fighting for businesses both large and small. But this is a time in which we are coming and I am coming to the floor fighting for community pharmacists who many times are the main source of health care in a community. They are the ones that are trusted. They are the ones that are needed. And it is time for this body to stand up for them, against the anticompetitive tactics of PBMs and the bullying behavior that has got to stop.