Rep. Jake Auchincloss has been leading a bipartisan effort to pass the Pharmacists Fight Back Act (HR9096) to regulate what the Congressional supporters term “price gouging abuses by the Pharmacy Benefits Managers (PBMs) — the middlemen of drug pricing.” On September 19, the group held a press conference in front of the Capitol Building to highlight the ways in which the PBMs are driving up drug costs and favoring the three largest companies – CVS Health’s Caremark, Cigna’s ESI, and UnitedHealth Group’s OptumRx.
The Republican lead sponsor of the bill is Rep. Diana Harshbarger, from Tennessee, who is also a pharmacist. Legislators highlighted the number of independent pharmacies disappearing in their districts, priced out of the consumer market. Among the speakers were the parents of a young man who could not afford the new much higher price of his asthma medication and died from complications of an asthma attack.
When he introduced the bill in July, Rep. Auchincloss said, “The Pharmacists Fight Back Act reins in large PBMs responsible for hundreds of millions of dollars in overcharges via spread pricing in Medicaid-managed care plans. The bill implements a transparent pharmacy reimbursement model using market-based pricing benchmarked to the national average drug acquisition cost (NADAC). It also removes the ability of PBMs to restrict patient choice via network exclusions, and protects community pharmacists by prohibiting PBMs from steering patients to PBM-affiliated pharmacies.”
Praising his legislative initiative, Rep. Katherine Clark, House Minority Whip said, “Jake Auchincloss is a policy leader on lowering patients’ prescription drug costs. In his first term, he helped negotiate and pass the law that empowered Medicare to negotiate drug prices. Now he’s at the forefront of efforts to ensure that health insurers improve patient access and lower out-of-pocket costs.”
For two independent Newton pharmacies, Newton resident Rep. Auchincloss has been a champion, recognizing the service they perform for their customers. Keyes Drugs on Commonwealth Avenue in Auburndale has been in business since 1885. The Dinno family bought the pharmacy in 1985, and three generations now work there — and in their other four stores — with the fourth generation, Ray Dinno’s daughter, studying to be a pharmacist. Keyes is also a compounding pharmacy, providing tailored medication for humans and pets who require it. The family represents the core of professionals at the heart of Rep. Auchincloss’s proposed legislation. Ray Dinno praised his Congressman for his support in recognizing the importance of independent pharmacies, underscoring “his incredible understanding of the impact these important reforms will have for both our customers, who hopefully will save money…and the survival of community pharmacies, especially independent pharmacies.”
Union Pharmacy, which opened its first store on Union Street in Newton Centre in 2019, now has two other locations — in Newtonville and Needham. Its owner, Dr. Xiaoyan Qin — who was Rep. Auchincloss’s guest at President Biden’s State of the Union Address in March — said that “Local independent pharmacists are community assets as we continue to grapple with healthcare inflation.” Repsime Guyumdzhyan, a registered pharmacist who works with Dr. Qin, contrasted the patient-focused service at Union Pharmacy, where the staff always answers patient questions and takes time to be sure they understand their medication. “Patients are not just numbers,” she said, adding, “Chains don’t offer personal service.”
Todd Brown, Executive Director of the Massachusetts Independent Pharmacists Association, told Fig City News: “The Massachusetts Pharmacists Association has consistently heard from members about the practices of the 3 top pharmacy benefit managers, CVS Caremark, Express Scripts, and Optum. Some of these concerns are related to the increased cost to consumers making medications unaffordable and causing consumers to choose between food and medication. Other concerns are related to the unsustainable reimbursement causing many pharmacies to close. This has dramatically reduced patient access to pharmacies and in some areas created pharmacy deserts. We support HR9096, the Pharmacists Fight Back Act, as this will help address the unfair reimbursement pharmacies have been experiencing for far too long.”
On September 20, the day after the Capitol Hill press conference, the Federal Trade Commission announced that it was suing Pharmacy Benefit Managers from Caremark Rx, Express Scripts, and OptumRx and their group purchasing organizations “for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products and shifted cost of high insulin list prices to vulnerable patients.”
Responding to the FTC’s suit, CVS said the FTC was wrong, blaming the drug manufacturers for the high cost of drugs: “CVS Caremark has led the way in driving down the cost of insulin for all patients: insured, uninsured, and underinsured,” the company said. OptumRx also denied wrongdoing, and Cigna/Express Scripts is suing the FTC for their “defamatory” action.
From a consumer perspective, longtime Keyes Drugs customer Tessa Gordon said she never goes to chain drug stores because of the excellent service she gets at Keyes. ”You really feel that it is a small business that cares.” Her fourteen-year-old terrier, Fletch, has also been a lifelong Keyes customer.