Warner, Cassidy Introduce Bipartisan Bill to Improve PBM Reimbursement Data, Protect Patients From Out-of-Pocket Costs

WASHINGTON –Today, U.S. Sens. Mark R. Warner (D-VA), a member of the Finance Committee, and Bill Cassidy, M.D. (R-LA), Chair of the Health, Education, Labor, and Pensions (HELP) Committee, reintroduced the Ensuring Accurate Payments to Specialty Pharmacies Act , bipartisan legislation to include specialty and mail-order pharmacies in federal drug acquisition cost surveys, improving the accuracy of prescription drug reimbursement data and rates, and bringing down costs for patients. “Specialty and mail-order pharmacies provide critical medications to patients across Virginia, and they should be reimbursed fairly and accurately for the care they provide,” said Sen. Warner. “I’m proud to introduce legislation that will give the Department of Health and Human Services a more accurate picture of what pharmacies actually pay for prescription drugs, help ensure reimbursement rates reflect those costs, and protect patients from out-of-pocket expenses.” “Although I’m a doctor, you don’t have to be a doctor to see patients aren’t able to afford the prescription drugs they need,” said Dr. Cassidy. “This legislation ensures that Medicaid and Medicare pay a fair and accurate price for specialty drugs so patients can access the best care at the lowest cost.” Pharmacy benefit managers (PBMs) are third-party intermediaries that manage prescription drug benefits and pharmacy networks on behalf of health plans, including Medicare Part D plans and some state Medicaid programs. Among other responsibilities, PBMs help determine which medications are covered by health insurance plans, how much patients pay for prescriptions, and how pharmacies are reimbursed. Under current law, the Secretary of Health and Human Services (HHS) requires retail community pharmacies to participate in surveys used to determine the National Average Drug Acquisition Cost (NADAC), which measures how much pharmacies pay to acquire prescription drugs. Medicaid programs and their PBMs use this data to help establish appropriate pharmacy reimbursement rates. The Ensuring Accurate Payments to Specialty Pharmacies Act would expand participation in these surveys to include specialty and mail-order pharmacies, providing more thorough data on drug acquisition costs and helping ensure PBM reimbursement rates cover the complete cost of prescription drugs. “The Virginia Pharmacy Association supports the Ensuring Accurate Payments to Specialty Pharmacies Act because accurate drug acquisition cost data is essential to establishing fair and sustainable pharmacy reimbursement. Expanding participation in the National Average Drug Acquisition Cost (NADAC) survey to include specialty and mail-order pharmacies will strengthen the integrity of reimbursement benchmarks and help ensure pharmacies are reimbursed based on more complete and representative data. We appreciate Senator Warner’s continued leadership on policies that promote transparency and strengthen patient access to pharmacy services,” said Jamie Fisher, Executive Director, Virginia Pharmacy Association. Read the full bill here . ###