Altoona Times

State lawmakers in Pennsylvania, including Sen. Judy Ward, Sen. Christine Tartaglione, Rep. Jessica Benham, and Rep. Valerie Gaydos, are advocating for reforms to address the increasing challenges faced by community pharmacies in the state. The issue at hand revolves around the role of pharmacy benefit managers (PBMs) in the healthcare system, which is contributing to rising prescription costs and the closure of many pharmacies.

Sen. Judy Ward highlighted the impact of PBMs on community pharmacies, stating, "Because of PBMs, our commonwealth’s community pharmacies are faced with Medicaid reimbursement costs that do not cover the expenses incurred to purchase drugs." The dominance of three major PBMs - CVS Caremark, Express Scripts, and Optum Rx - has led to a significant increase in Pennsylvania's Medicaid spending on pharmacy benefits, reaching $3.7 billion annually.

One example of the detrimental effects of PBM pricing can be seen through the closure of nine Mainline Pharmacy locations in the greater Pittsburgh region. Rep. Jessica Benham expressed concern over this situation, noting, "This happened despite a record year for filling prescriptions because they lost $350,000 in the first six weeks of this year from PBM underpayments." The closure of other community pharmacies in underserved areas like Philadelphia further underscores the urgency of addressing this issue.

In response to these challenges, legislators have introduced bipartisan legislation in both the state House and Senate to bring transparency to the PBM process and protect community pharmacies. Rep. Valerie Gaydos emphasized the need for PBM reforms, stating, "Transparency is critical to solving this problem because no one really knows how much PBMs are making at the expense of Pennsylvania’s dedicated community pharmacies and their patients."

The proposed legislation aims to compel PBMs to report financial information on rebates and payments received from drug manufacturers, as well as restrict certain practices that negatively impact pharmacies and patients. Sen. Christine Tartaglione highlighted the importance of enacting comprehensive PBM reform, echoing the sentiment that the time to address these issues is now.

The push for PBM reforms in Pennsylvania has garnered support from various quarters, including Governor Josh Shapiro, who cited the need for such reforms in his recent state budget address. The issue has also gained national attention, with figures like pharmacist Dr. Chichi Ilonzo Momah and entrepreneur Mark Cuban advocating for transparency and cost reduction in the prescription drug supply chain.

The legislators involved in this initiative are working towards ensuring that Pennsylvania's community pharmacies can continue to serve their communities and provide essential medications to families in need. By addressing the challenges posed by PBMs, they aim to protect the viability of these pharmacies and lower prescription costs for Pennsylvanians.