September 22, 2023
By:
U.S. Representative John Rose (TN-06) recently joined three House Members, Reps. Earl L. “Buddy” Carter (GA-01), Raja Krishnamoorthi (IL-08), and Debbie Dingell (MI-06), in introducing the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act. The legislation would improve options and access to prescription drugs for seniors, bring pharmacy benefit managers (PBMs) in alignment with Medicare plans, and ultimately allow seniors to shop at their local pharmacy.
The bill would also modernize Medicare and prevent PBMs from discriminating against pharmacies that are willing to contract with them, helping seniors to seek care closer to home. Under Medicare Part D, plan sponsors are required to (i) have standard terms and conditions that are “reasonable and relevant” and (ii) allow any pharmacy willing to accept the terms and conditions to participate in the sponsor’s network. This bill would explicitly ensure that PBMs are required to comply with this standard, bringing them in line with plan sponsors.
“Independent pharmacies are integral to the health care needs of rural communities in Tennessee and across the country,” said Rep. Rose. “We should protect them by holding PBMs accountable. I am proud to support this bipartisan, commonsense legislation on behalf of Tennessee’s independent pharmacists and patients.”
“Seniors should be able to fill their prescriptions at the pharmacy that works best for them, not the PBM. Especially in rural areas, including Georgia’s First Congressional District, access to your local pharmacy is critical. I’m proud to lead this bipartisan bill, which will allow independent pharmacies to compete on a more level playing field and bring accountability to PBMs,” said Rep. Carter.
“We must hold pharmacy middlemen accountable by ending practices that steer patients away from their preferred community pharmacists while driving up their prescription drug prices. Our bipartisan legislation will close anti-competitive loopholes that PBMs use while ensuring small pharmacists are given reasonable contract terms to provide patients with fair prices on the medications they need,” said Rep. Krishnamoorthi.
“All Americans, but especially seniors, should be able to conveniently access their necessary prescriptions. However, we too often hear about exploitative PBM practices complicating access to the pharmacies seniors depend on,” said Rep. Dingell. “Independent pharmacies are often an invaluable resource in underserved communities, and this legislation will ensure they can compete. Not only will it improve PBM accountability, but it will ensure seniors can get their medications closer to home and at the pharmacies they trust.”
The NO PBMs Act is supported by the National Community Pharmacists Association, American Pharmacists Association, National Association of Specialty Pharmacy, and the American Pharmacy Cooperative, Inc.
“Every day across the country, pharmacy patients get letters from their PBMs telling them that they have to start using a PBM-owned pharmacy. Or they get a letter stating that their current pharmacy is no longer ‘preferred’ in the plan network,” said American Pharmacies President Laird Leavoy. “The letters often imply that scripts may no longer be filled at non-PBM pharmacies. It’s alarming and confusing to older patients, who out of fear often switch their business to the PBM’s pharmacy. Steering is a conflict of interest that decreases transparency and competition in the pharmacy services market. It drives up pharmacy care costs while harming patient care, especially in rural and medically underserved areas.
U.S. Senators Marsha Blackburn (R-TN) and Joe Manchin (D-WV) introduced a companion bill in the Senate.
U.S. Representative John Rose is currently serving his third term representing Tennessee’s Sixth Congressional District and resides in Cookeville with his wife, Chelsea, and their two sons, Guy and Sam. The Sixth District includes Cannon, Clay, Cumberland, DeKalb, Fentress, Jackson, Macon, Overton, Pickett, Putnam, Smith, Sumner, Trousdale, Van Buren, and White counties as well as portions of Davidson, Scott, Warren, and Wilson counties. Representative Rose is an eighth-generation farmer, small business owner, and attorney, and currently serves on the House Financial Services Committee and House Agriculture Committee.