CHARLESTON, W.Va. – U.S. Senator Shelley Moore Capito (R-W.Va.) recently joined a group of 32 bipartisan Senate colleagues in sending a letter—led by U.S. Senator James Lankford (R-Okla.)—to Senate Majority Leader Chuck Schumer (D-N.Y.) and Minority Leader Mitch McConnell (R-Ky.) calling on them to rein in pharmacy benefit manager (PBM) practices that hurt patients and pharmacies.

“The need to act is more severe now than ever before. In 2023 there were over 300 independent pharmacy net closures—almost one per day. Unfortunately, that trend has only grown in 2024. Pharmacies across the country have been forced to close their doors because PBMs have continued to reimburse them significantly less than it costs the pharmacy to even purchase the drug. This is unsustainable, especially for small family businesses. The impacts of these closures only hurt already-struggling communities by decreasing the number of quality health care providers and likely increasing costs for seniors,” the senators wrote. 

BACKGROUND:

This letter follows a previous letter Senator Capito joined calling on Leaders Schumer and McConnell to take action on PBMs in March of this year.

Earlier this year, Ranking Member Capito joined a letter to the Federal Trade Commission (FTC) urging it to complete its investigation into PBMs.

In June of 2023, Ranking Member Capito introduced the Protect Patient Access to Pharmacies Act, to ensure that all pharmacy price concessions are assessed at the point of sale and eliminate the retroactive nature of direct and indirect remuneration (DIR) clawback fees imposed by PBMs.

In March of 2023, the Pharmacy Benefit Manager Transparency Act that Senator Capito co-sponsored passed the Senate Commerce, Science, and Transportation Committee. The legislation currently awaits a full Senate vote.

Full text of the letter can be found here or below.

Dear Majority Leader Schumer and Minority Leader McConnell, 

We write to encourage you to include critically-needed Pharmacy Benefit Manager (PBM) reforms in any legislative vehicle that may be brought up for a vote at the end of the 118th Congress.

A number of committees in both the Senate and the House have passed meaningful legislation that would rein in certain PBM practices that harm patients and local pharmacies. In the Senate, the Senate Finance Committee nearly unanimously passed the Modernizing and Ensuring PBM Accountability Act and the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, the Health, Education, Labor, and Pensions (HELP) Committee passed the Pharmacy Benefit Manager Reform Act, the Commerce Committee passed the Pharmacy Benefit Manager Transparency Act, and the Judiciary Committee passed the Prescription Pricing for the People Act. These proposed policies would increase transparency, realign incentives for PBMs and patients, ensure pharmacies are adequately reimbursed, and ensure that patients benefit from decreased drug costs.

To not advance these important policies before the end of this Congress would be a waste of substantial progress made and would deny patients and pharmacists across the country the relief they deserve.

In December of last year, the Centers for Medicare & Medicaid Services (CMS) wrote to PBMs and plans: ‘We are hearing an increasing number of concerns about certain practices by some plans and [PBMs] that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.’ More recently, the Federal Trade Commission (FTC) released an interim report which noted that ‘PBMs can often exercise significant control over which drugs are available, at what price, and which pharmacies patients can use to access their prescribed medications,’ and filed a complaint alleging that ‘PBMs have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication.’

The need to act is more severe now than ever before. In 2023 there were over 300 independent pharmacy net closures—almost one per day. Unfortunately, that trend has only grown in 2024. Pharmacies across the country have been forced to close their doors because PBMs have continued to reimburse them significantly less than it costs the pharmacy to even purchase the drug. This is unsustainable, especially for small family businesses. The impacts of these closures only hurt already-struggling communities by decreasing the number of quality health care providers and likely increasing costs for seniors.

Should any long-term policy priorities be attached to an end-of- year spending package, PBM reforms should be included in order to end the 118th Congress with success that will help protect pharmacies and decrease costs for patients across the country.

Sincerely,

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