The National Community Pharmacists Association (NCPA) is spearheading an urgent campaign for comprehensive pharmacy benefit manager (PBM) reform legislation, with critical deadlines approaching as Congress enters its final sessions of the year. The initiative focuses on transforming prescription drug pricing and pharmacy compensation practices across both public and private sectors.
Key Reform Priorities
NCPA's reform agenda centers on two major programs. The first targets Medicaid Managed Care prescriptions, pushing for a pass-through payment model similar to Medicaid fee-for-service prescriptions. This would ensure pharmacies receive reimbursement based on acquisition costs plus a professional dispensing fee aligned with state-specific cost determinations.
The second priority focuses on Medicare Part D reform, where NCPA is advocating for the Centers for Medicare and Medicaid Services (CMS) to establish clear definitions for "reasonable and relevant" contract terms. This change aims to address the challenging "take-it-or-leave-it" contracts that independent pharmacies currently face from PBMs and Part D plans.
Impact on Community Healthcare Access
Current market conditions have led to the closure of approximately one independent pharmacy per day across the United States, creating concerning gaps in healthcare access. Research conducted in partnership with the University of Southern California has revealed that pharmacy deserts predominantly form when independent pharmacies close, particularly affecting underserved and low-income communities.
"It's very discouraging to see when an independent pharmacy closes, a pharmacy desert may form, and that is definitely not a good thing for patient access," states Ronna Hauser, SVP of policy and pharmacy affairs at NCPA.
"Finish the Fight" Campaign Progress
NCPA's recent "Finish the Fight" campaign has gained significant traction, successfully mobilizing nearly 40,000 patients to advocate for PBM reform with their congressional representatives. The campaign employs a multi-channel approach, including television advertisements, social media outreach, and print media, targeting key congressional districts nationwide.
Clinical Service Integration and Future Outlook
Beyond traditional dispensing services, NCPA is working with the Community Pharmacy Enhanced Services Network (CPESN) to establish direct contracts with health plans for clinical services. This initiative aims to secure fair compensation for pharmacists' expanded role in patient care, including vaccine administration, COVID-19 treatment management, and other clinical services that help reduce hospitalizations.
The push for reform has garnered unique bipartisan support, with Hauser noting, "It's, in essence, the most important topic in healthcare reform right now that is not a topic where people take sides and bicker and argue with each other. Everyone agrees that this has to be done."
Network Access Standards Reform
NCPA is actively engaging with CMS to update Part D network access standards, which have remained unchanged since the program's inception. The organization's pharmacy access mapping tool demonstrates significant gaps in the current standards, particularly in underrepresented and low-income communities.
As American Pharmacist Month approaches, NCPA emphasizes the critical role of pharmacists in healthcare delivery while highlighting the urgent need for systemic reform in prescription drug pricing and pharmacy compensation models.
