NACDS launches media campaign urging ‘real reform’ of PBMs

The National Association of Chain Drug Stores (NACDS) has kicked off a multimedia campaign calling for the federal government to crack down on pharmacy benefit managers (PBMs).

Launched Wednesday, the “Real Reform” ad campaign spans broadcast, cable, web-based news and digital channels. The media push is led by a national 30-second TV/video spot titled “Real Reform” that addresses what Congress must do to “stop abusive PBM tactics” while also boosting oversight of PBMs, “ensuring accountability, transparency and fairness,” said Arlington, Virginia-based NACDS, which represents chain retail pharmacy operators.

Federal reform is needed to combat PBM practices that hike prescription drug prices for consumers and levy high fees on pharmacies, according to NACDS. Key areas for reform cited in the media campaign include skyrocketing DIR fees on pharmacies and formulary exclusions that reduce patients’ medication choices. The association noted that the campaign also highlights the need to focus on reforms that safeguard Americans on Medicare and Medicaid.

“People must be at the center of care,” NACDS President and CEO Steven Anderson said in a statement. “Americans should be able to go to any pharmacy and have access to their medicines at an affordable price. PBM reform is needed now, and any proposed PBM legislation that does not include Americans served through Medicare and Medicaid—and their pharmacies—is not real reform.”

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NACDS said “pharmaceutical benefit manipulation” drives up drug prices, limits access to certain medications and puts financial pressure on pharmacies, especially those in rural and underserved communities. From 2014 to 2022, 1,357 medications were excluded from at least one PBM formulary for at least one year, and over the past decade, direct and indirect remuneration (DIR) fee have soared 107,400%, the association reported.

DIR fees refer to post-point-of-sale compensation received by PBMs and Medicare Part D plan sponsors for prescription drugs. Used in the calculation of final Medicare payments to Part D plans, these fees primarily are rebates paid by drug manufacturers but also include concessions paid by pharmacies, such as pay-for-performance network fees and reimbursement reconciliations. As a result, DIR fees affect the final cost of a drug for payers and the price paid to pharmacies for a drug. A pillar of retail pharmacy industry efforts to crack down on DIR fees has been a lack of transparency for these costs and the fact that they’re often charged retroactively, after the point of sale for drugs dispensed to seniors under Part D. Pharmacies of all sizes have felt the financial squeeze, namely small operators.

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NACDS, which represents national and regional pharmacies in drug store, supermarket and mass retail settings, stepped up its efforts for stronger oversight of PBMs in recent years. In 2023 alone, the association said it has pushed for change at all levels of government and, as a result, the enactment of 31 bills across 27 states led to 55 policy changes consistent with NACDS PBM reform and reimbursement priorities. That builds on the enactment of 101 state PBM reform bills combined in 2021 and 2022.