Chris Coons Questions PBM Reimbursement Practices for Independent Pharmacies

Concerns Over PBM Practices

• 💡 Senator Coons highlighted that Delawarians paid over $24 million in unnecessary prescription drug costs between 2018-2020 due to PBM practices.
• 🎯 PBM reform laws have been unanimously passed in Delaware, indicating bipartisan support for such measures in Congress.
• ⚠️ Practices by Pharmacy Benefit Managers (PBMs) can make it difficult for patients, especially those undergoing cancer treatment, to access life-saving medications.

Reimbursement Challenges for Independent Pharmacies

• 📉 Reports indicate that up to 80% of rural and independent pharmacies receive reimbursement below the cost of procuring and dispensing certain drugs.
• 💊 An independent pharmacy owner in Delaware can no longer afford to stock expensive treatments like HIV medications and GLP1s due to unpredictable reimbursements after PBM fees.

Transparency in the Reimbursement Process

• 🔍 Juan Carlos Scott explained that pharmacies contracting with PBM networks have some transparency, with over 85% of independent pharmacies using a Pharmacy Services Administrative Organization (PSAO) to negotiate on their behalf.
• 💰 Scott acknowledged that spread pricing is a reality and that greater transparency is needed throughout the drug supply chain to understand where costs are being incurred.
• ❓ Dr. McDana questioned the opacity of rebates and suggested exploring models where actual drug costs are known, as current rebate structures make this impossible.

Advocating for Transparency and Fair Practices

• ✅ Dr. Faustst stated that PBMs should operate with the same level of transparency as their company, including passing through rebates to clients.
• 🤝 Direct contracting between an employer and an independent pharmacy demonstrated potential for savings, patient satisfaction, and pharmacy viability.
• 🗣️ The discussion emphasized the need for greater transparency to level the playing field for independent and rural pharmacies.