Lawmakers Focus on Community Pharmacists’ Generic Drug Payment Concerns

By Kevin Schweers

Two Georgia Republicans—U.S. Reps. Doug Collins and Austin Scott—took for the floor of the U.S. House of Representatives the evening of April 9th to express their strong support for independent community pharmacists and, in particular, the serious problems that they’ve encountered with secretive and often outdated maximum allowable cost (MAC) reimbursement limits set by pharmacy benefit managers (PBMs) for generic drugs in Medicare Part D drug plans.

To watch the video click on the image below.


Rep. Scott spoke of his personal interactions with community pharmacists about this issue.

“Just recently, I met with a pharmacist from my district, Mr. Daryl Reynolds; and like many other pharmacists from the Eighth District, he runs a small store and has been hurt by the lack of transparency and pricing. Ultimately, that hurts his patients because it makes it hard for him to stay in business,” he said.

“We in the rural parts of the country need our rural and community pharmacists, and pharmacists like Daryl are a vital component of our national health care system, for those of us who live great distances from the metropolitan areas,” Scott added. “They know us by name. They know our drug interactions. They are able to work with us and our physicians. They make sure that we are taken care of and that we are taking the right medications for the problems that we may have.

Scott explained the common sense need for reforms to how the MAC situation is playing out for small pharmacies.

“In many cases, our community pharmacists—because of the way the pharmacy benefit managers operate—are reimbursed at less than what the drug actually costs the small community pharmacy,” he said. “These contracts are nonnegotiable. They are vague and opaque, and most of the time, it puts a small community independent businessman up against a multibillion dollar company.

“These PBMs and their maximum allowable cost prices, they don’t update them when the prices go up, and that leaves the pharmacist paying more, again, for the drug than they actually get reimbursed for the drug, and these are the pricing practices that need to be fixed for our community pharmacists.”

Collins echoed and expanded upon the concerns expressed by Scott.

“Generic drugs account for nearly 80 percent of prescriptions, but a community pharmacist is kept in the dark as to how pharmacy benefit managers determine MAC rates for these medications,” he said. “You see, Congress and CMS must step in to give pharmacists more transparency into this process, so they are empowered to evaluate if specific contracts would help them better serve our neighborhoods and families.”

Rep. Collins spoke convincingly about the need for bipartisan legislation he introduced that day along with Rep. Dave Loebsack (D-Iowa), H.R. 4437, the Generic Drug Pricing Fairness Act. NCPA has endorsed the proposal.

“It will provide clarity to plan sponsors and pharmacies regarding how MAC pricing is determined,” Collins said of H.R. 4437. “It will establish an appeals process in which a dispensing provider can contest a listed MAC price. It provides standardization for how products are selected for inclusion on MAC list, and it compels PBM disclosures about the use of multiple MAC lists and whether or not MAC pricing is utilized for mail order products.”

In addition, Collins hit on other hot button topics for pharmacists, including exclusionary “preferred” pharmacy plans and the need for allowing participation by “any willing pharmacy.”

NCPA greatly appreciates the continued leadership of these Representatives on behalf of their constituents and the pharmacists who serve them.

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