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Central Louisiana News

Wednesday, March 19, 2025

Bill introduced to address pharmacy benefit manager pricing in Medicaid

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Senator Bill Cassidy | Sen. Bill Cassidy Official Website

Senator Bill Cassidy | Sen. Bill Cassidy Official Website

U.S. Senators Bill Cassidy, Peter Welch, Roger Marshall, and Mark Warner have introduced the Protecting Pharmacies in Medicaid Act to address pricing practices by pharmacy benefit managers (PBMs). The bill targets 'spread pricing,' where PBMs overcharge Medicaid and underpay pharmacies, increasing costs and threatening independent pharmacies' survival. The legislation is projected to save Medicaid $2 billion over the next decade.

Dr. Cassidy emphasized that "taxpayers should not be cheated by those looking to take advantage of Medicaid." Senator Welch noted the importance of community pharmacies for rural areas, stating that "this bill takes an important step to limit PBMs’ abusive pricing practices."

Senator Marshall pointed out that "prohibiting PBM spread pricing will cut costs for prescription drugs relied upon by Medicaid enrollees while simultaneously preserving access to local pharmacies." Senator Warner highlighted the critical role of independent pharmacies in providing healthcare and described the bill as a means to end "the abusive practice of spread pricing."

The decline of independent pharmacies has been notable from 2018 to 2021, with more closures than openings nationwide. In Louisiana, this trend has significantly impacted rural communities.

The proposed legislation mandates that PBMs pass Medicaid payments directly to pharmacies and requires participating pharmacies to report National Average Drug Acquisition Costs (NADAC) for improved transparency.

The Food Industry Association (FMI), National Community Pharmacists Association, and the National Association of Chain Drug Stores endorse the bill. Steven C. Anderson from NACDS expressed support for these reforms, urging swift congressional action.

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