The Future of the Protecting Pharmacies in Medicaid Act Requires Advocacy

Pharmacy Times: The Protecting Pharmacies in Medicaid Act focuses on Medicaid, but how do you feel the practices of pharmacy benefit managers (PBMs) in the commercial insurance market could affect pharmacies and patients? Could there be similar legislation for commercial plans?

Kaite Krell, MPH: Definitely. So, all of the bad practices that you're seeing in Medicaid and in Medicare are also happening in commercial—maybe in a slightly different way, or a slightly different variation, just depending on how contracts and the government programs work naturally. But the fact that, like we said earlier, with patient steering, that's not happening just in Medicare and Medicaid, that's happening all across the board. And so, there was legislation that was introduced last year, and there is going to be some legislation introduced this year. I know that Representative Miller-Meeks (R-IA) is looking into this issue again. Senator Cassidy (R-LA) had introduced legislation on this last year, and so I know that Representative Miller-Meeks is going to be dropping a pharmacy bill. It's not pharmacy as much. It's pharmacy adjacent. It is [focused on] the delinking policies, but they are also working on commercial pharmacy legislation that they'll be dropping in the coming weeks. And so, there are steps being made in the commercial world as well. We have been prioritizing Medicare and Medicaid, because, as I said earlier, it is the majority of the business for the community pharmacies. But, you know, the other 45% is commercial, and so we would love to see any steps moving forward in commercial and commercial reforms that were included in that end-of-year negotiated package did also save taxpayer dollars, and so we would love to see that included, if it moves forward.

Pharmacy Times: Is there anything you’d like to add?

Kaite Krell, MPH: I think the biggest thing to think about right now is the reintroduction of this legislation and of other PBM reform legislation that has come in the last couple of weeks and will be coming in the next couple of weeks. It is a great step forward, and we're really excited to see it. However, most, if not all, of this was agreed upon at the end of the year, and it was all included in 1 package, and so we had a big campaign asking all of our pharmacies and all of our pharmacists to get 10 of their patients to just write into Congress and ask them to get it over the finish line. And we had a huge outpouring of support right then, but now that it hasn't been included in the [continuing resolution] because they've been going toward skinny funding packages, we are seeing the Senate start to look forward at maybe just introducing that health care package—which was fully paid for, fully offset, and had all of the things that I have been talking about on both on the commercial side, Medicare, and Medicaid—reintroduced and pushed across the finish line. And we would love to see that happen again. And so, if any of the folks who are reading this want to ask for that standalone health care package with all of the PBM reforms included in it, we would love to see that, and we would love to get that push going again. The Senate is starting to look at it and get it across the finish line, but it's been a very interesting year, just in Congress and in government across the board. And so, this was bipartisan, bicameral last year. I think I can count, I will say on 1 hand, but we could maybe even go to 2, the number of people who oppose it. And when you have 535 legislators, when you can think of only a handful, that's huge. And so, we just need to remind everybody that this is important. Everyone has told me, if it came to the floor, we'd vote for it. And so, you just need to ask your legislators to make sure that leadership gets it to the floor because that's the biggest hurdle right now, is just getting them to bring it up for a vote. And so, if we can ask folks to go, ask their reps to do that, that would be amazing. But other than that, I think that's all I've got.