APCI: Congress misses opportunities for prescription drug reform under reconciliation bill

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BESSEMER, Alabama – (COMMERCIAL THREAD) – Congress is ignoring important opportunities to reform prescription drug pricing in Medicaid Managed Care in the Rebuild Better Act, according to officials at American Pharmacy Cooperative, Inc. (APCI).

Early discussions on the bill focused on language that would end the practice of “tiered pricing” by pharmacy benefit managers (PBMs) and Medicaid managed care organizations (MCOs) in Medicaid. This is a practice where these intermediaries charge an insurer a single price for a prescription drug, reimburse the dispensing pharmacy for a lower amount, and keep the difference. This wording has not been incorporated into the current version of the bill.

APCI CEO Tim Hamrick made the following statement:

“The Rebuild Better Act has helped effect real change in the Medicaid managed care system in the United States by ending the PBM prescription drug pricing games, increasing transparency and equitably reimbursing community pharmacies. Implementing these changes would have saved taxpayers $ 1 billion in federal spending alone, while strengthening America’s community pharmacies that care for some of this country’s most vulnerable patients.

Added APCI Director of Legislative Affairs Bill Eley:

“The reluctance to tackle prescription drug reform for Medicaid-managed care in the Rebuild Better Act is curious with the abuse of PBM and MCO in the foreground. States have discovered hundreds of millions of dollars in prescription drug overcharges by PBMs and OLS in the Medicaid managed care system. One of the largest MCOs in the country has already paid more than $ 200 million to settle investigations in four states. Inaction also follows explosive hearing in Ohio exposing lingering problems with PBM / MCO prescription drug practices, Medicaid head of state conceding PBM recoveries “skewing all economic dynamics [in Medicaid managed care]. ‘”

The APCI remains committed to the reform of Medicaid managed care and working with Congress at the federal level as well as state general assemblies to end the cycle of abuse. Greg Reybold, director of health policy at APCI concluded:

“Unfortunately, many MCOs and PBMs have grown fat by feeding off patients, community pharmacies and US taxpayers by exploiting prescription drug prices and directing patients to pharmacies affiliated with MCO and PBM. APCI will continue to fight for the reform of Medicaid managed care and to hold PBMs and MCOs accountable. The system needs to be repaired.


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