THIS WEEK the Legislature is negotiating the final budget version to present to the Governor before adjourning March 9. Each chamber has proposed budget amendments that – if incorporated in the final version – would establish one single, state-directed PBM to administer all pharmacy benefits for the Medicaid managed care program. This reform would prevent PBM tactics that hinder Medicaid patient access to needed medications, contribute to pharmacy staffing shortages, and cause pharmacies to close.
The Department of Medical Assistance (DMAS) contracts through separate Medicaid managed care organizations (MCOs) that each own their own PBM. Not only do PBMs provide little if any transparency on drug prices, reimbursements, and rebates – they are overcharging DMAS and underpaying pharmacies. A 2019 State Medicaid Agency study found the breakeven pharmacy dispensing fee at the time was $10.65, while today’s average MCO dispensing fee paid to pharmacies is $1.09.
Proposed Budget Amendments to SB30 and HB30 (Items 288#34S and 288#31H) would provide the Commonwealth with control, transparency, and access to rebate dollars. They would provide a sustainable structure for patients to have widespread access to medications at their pharmacy of choice and save an estimated $32 million in administrative and other fees per a Virginia General Assembly-directed study. They would also grant more direct ability to ensure network adequacy to protect Federal Match Funding for the State Medicaid Program.
Support for these amendments is critical! Ohio, West Virginia, New York, and Kentucky have all taken similar steps to take state funds out of the hands of PBMs and to directly control costs, make reimbursement predictable, protect taxpayer dollars and improve patient access to medications. As a result, they now have drug pricing transparency, accountability and have saved their states millions of dollars.
Join in this NACDS RxIMPACT campaign to tell Virginia legislators to put patients and the pharmacies that serve them over PBM profits. According to 2023 data, five counties in Virginia do not have any pharmacies, while fifteen counties have only one pharmacy. This is not equitable access for patients!
Act today! This campaign will send one of the two sample letters featured on the right. The top sample letter will be directed to your legislators that are directly involved in budget negotiations. The other sample letter will be directed to any other legislators. To get started, simply visit the ENTER YOUR INFORMATION section on the bottom right, and the system will send personalized letters to your state legislators!
If you have any questions or would like any assistance, please contact Jill McCormack via email or at 717-592-8977 or Heidi Ecker via email or telephone at 703-837-4121.