Legislative action could happen ANY TIME! Please ACT NOW to ensure leaders have the benefit of your powerful voice as a member of the pharmacy community. NACDS RxIMPACT needs your help telling key leaders in the General Assembly to vote YES when the bill is brought forward for a full California General Assembly vote. We also need to articulate the need for PBM reform to Governor Newsom so he is prepared to sign SB 966 into reality.
Californians and their pharmacies need pharmacy benefit manager (PBM) reform TODAY. We see this every day: PBMs profit exorbitantly while driving up Americans' prescription drug costs, while reducing Americans' access to medications and pharmacies, and while forcing pharmacies to close - chains and independents alike. Estimates project PBMs more than doubled revenue over the last decade and will do so again – reaching $800+ billion by decade’s end. Things continue to worsen!
This important legislation:
Protects Patient Choice of Pharmacies: Pharmacies not owned by a PBM can participate in a PBM network as preferred provider if the pharmacy is willing to accept the same terms/conditions that the PBM set for PBM-owned pharmacies as a condition of preferred network participation status.
Preserves Patient Access to Pharmacies: California's Attorney General retains all authorities to maintain or restore competitive, fair, and honest markets and prosecute state and federal antitrust and unfair competition violations. Licensing PBMs would create regulatory pathways and subsequent enforcement mechanisms to help ensure fair and transparent processes. Licensing PBMs may also benefit patients by lowering drug prices, improving quality of care, and expanding access to medications.
Addresses Higher Health Care Costs: Prohibits a PBM from directly or indirectly retroactively deny or reduce a claim after the claim has been adjudicated, unless: the original claim was submitted fraudulently or because the pharmacy or pharmacist had already been paid for the pharmacist services. Prevents PBM from charging a fee to process a claim electronically.
Delaying PBM reform would allow PBMs to continue to overcharge employers, raise healthcare costs for taxpayers, and force pharmacies to close. A recent Washington study showed for a subset of matched claims between the plan sponsor and the pharmacies, the average plan sponsor (employer) costs were approximately $165,000 higher (roughly 80% more) than the reimbursement provided to pharmacies (about $8 more per prescription). (Washington Health Alliance/Washington State Pharmacy Association - 3 Axis Advisors Study).
ACT TODAY! Simply enter your contact information in the right column, place “one click”, and the system will generate personalized communications to Governor Newsom and key General Assemblymembers. If you have any questions or would like any assistance, please contact Heidi Ecker via telephone at 703-837-4121 or email at hecker@nacds.org.