PBMs pocket hundreds of millions of taxpayer dollars through their non-transparent actions while impacting community pharmacies, leading to their closure. In 2024 alone, over 70 chain and independent pharmacies have already suffered this fate! Senate Bill 1000 and House Bill 1993 would stop this predatory practice once and for all!
PBMs are supposed to negotiate good prices with drug companies for prescription drugs through Medicaid – and they do. But the savings they generate aren’t being passed on to Pennsylvania families! Instead, those Medicaid dollars are going right into the pockets of PBMs.
Pennsylvania’s annual Medicaid spend on the pharmacy benefit has drastically increased, from $1.41 billion in 2013 to $3.7 billion, according to the National Community Pharmacy Association (NCPA). Not only is that increasing the cost of prescriptions, but it’s leading to the increased closure of community pharmacies.
Absent strong regulation and transparency, PBMs engage in a number of practices that have direct negative impacts on pharmacies and cost taxpayers billions, including:
- Reimbursement rates that are less than what pharmacies pay for a drug;
- Directing patients to use a preferred pharmacy through mandatory mail-order requirements, a restricted pharmacy network, or charging higher co-pays at pharmacies that are not part of the PBM’s network;
- Spread pricing, which occurs when PBMs reimburse a pharmacy for a drug and then bill the insurer at a higher price to collect more tax dollars; and
- Taking back payments for prescriptions that were already dispensed.
