ALEXANDRIA, Va. — The National Community Pharmacists Association is using social media, digital advertising, and a grassroots effort to push congressional budget makers to include a provision eliminating pharmacy benefit manager spread pricing under the Medicaid program and reimburse pharmacies in a fairer and more transparent manner.
“PBM spread pricing costs federal and state taxpayers hundreds of millions of dollars every year. It does nothing to reduce the cost of drugs for Medicaid patients, and it drives local pharmacies out of business,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA.
Spread pricing is what happens when pharmacy benefit managers, known as PBMs, charge insurance plans like Medicaid one price for prescription medications, reimburse pharmacies that dispense them a much lower price, and then keep a big chunk of the difference for themselves. According to the Congressional Budget Office, banning PBM spread pricing will save the federal government $1 billion over the next 10 years in federal match dollars. Plus, states would also save hundreds of millions of dollars in Medicaid costs. Many states are already getting wise to the questionable practice. Ohio, for example, found spready pricing cost them $225 million per year. In Kentucky, spread pricing cost them an additional $124 million.
“If the goal for policymakers is to provide the best health care to low-income residents at the best price for taxpayers, they must eliminate spread pricing,” said Hoey. “Federal and state taxpayers are getting ripped off, local pharmacies are being squeezed out of the programs, and the PBMs are making a fortune.”
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