Independent Pharmacy News Headlines for Week of 12-15-23

PBM reform is the big news story of the week.

U.S. Capitol image

AAP celebrates the passage of H.B. 5378 in the U.S. House of Representatives

This week, the U.S. House of Representatives passed H.R. 5378, Lower Costs, More Transparency Act. According to NCPA, this legislation shines a light on PBM operations and tactics and encourages reform. It would help provide desperately needed relief while also saving taxpayer resources, prohibiting spread pricing and seeing that pharmacies are paid in a way that would cover their dispensing costs.

This bill also includes the Drug Price Transparency Act which would save taxpayers more than $1 billion over the next 10 years and prohibit spread pricing.

The bill now moves on to the U.S. Senate for passage. We will keep you informed when the vote is scheduled.

CMS issues warning to PBM-insurers, calling for reform

The second PBM reform news story is the warning issued by CMS to PBM insurers, calling on them to make sure independent pharmacies are adequately reimbursed.

The letter goes on to state, “In addition, we know that the increasing level of vertical integration that is occurring among plans, PBMs, and their own pharmacies has the potential to result in anticompetitive behavior and place independent pharmacies at a disadvantage. We urge plans and PBMs to engage in sustainable and fair practices with all pharmacies – not just pharmacies owned by PBMs – and we are closely monitoring plan compliance with CMS network adequacy standards and other requirements.” Read the full letter here

Cigna calls off merger with Humana

According to Reuters, U.S. health insurer Cigna has called off its attempt to negotiate an acquisition of Humana after the pair failed to agree on price. Cigna has announced plans to buy back $10 billion worth of shares.

A Cigna-Humana combination would have created a company with a value exceeding $140 billion, based on their market values, but was certain to attract fierce antitrust scrutiny. The discussions came six years after regulators blocked other deals between Humana-Aetna and Cigna-Anthem.

Cigna is still exploring the sale of its Medicare Advantage business, which manages government health insurance for people aged 65 and older, and its performance has been disappointing to investors.