To Cut Prescription Drug Costs for Seniors, Tester Reintroduces Bipartisan Bill

Legislation would rein in pharmaceutical middlemen, protect rural pharmacies

(U.S. Senate) – As part of his ongoing push to lower prescription drug prices and protect rural health care providers, U.S. Senator Jon Tester has reintroduced his bipartisan Improving Transparency and Accuracy in Medicare Part D Drug Spending Act to help save seniors money and provide certainty to rural pharmacies across Montana.

“Rural health care providers are the backbone of towns and cities across Montana,” Tester said. “But just like any small business, these hospitals, clinics, and pharmacies need stability and certainty to survive. That’s why we’re introducing this bipartisan bill once again, to ensure neighborhood pharmacies aren’t subjected to the financial whims of pharmaceutical bureaucrats and middlemen.”

Under the current system, pharmacists that serve Medicare Part D patients often work with a Pharmacy Benefits Manager (PBM) who negotiates drug prices and handles reimbursement to pharmacies from insurers. PBMs charge pharmacies a fee for this service. But increasingly, PBMs have been assessing these fees retroactively, weeks or even months after the prescription has been filled. These fees are impossible to estimate for small, rural pharmacies that already operate on thin margins and can also artificially inflate costs at the pharmacy counter.

That’s why Tester and Senator Shelley Moore Capito (R-W.Va.) have reintroduced their bipartisan Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, to hold these pharmaceutical middlemen accountable by prohibiting PBMs from assessing these fees on Medicare Part D claims. Tester also recently secured language in the 2019 Health and Human Services Appropriations Bill directing the Centers for Medicare and Medicaid Services (CMS) to address the issues of retroactive PBM fees through rulemaking and regulation.

In response to Tester’s appropriations language, CMS released a proposed rule in November that amends the definition of “negotiated price” to include all pharmacy price concessions at the point of sale-including these burdensome PBM fees. In February, Tester and Capito led a bipartisan letter-signed by 27 Senators-urging CMS to finalize this rule, which would prohibit PBMs from assessing these fees retroactively and give small, rural pharmacies the financial certainty they need to survive.

Read more about Tester’s work to lower prescription drugs prices HERE.