TPA to Legislators: Enforceable PBM Reform Cannot Wait
Nashville, TN (February 8, 2022) – Pharmacists across the country have long felt the damaging effects of Pharmacy Benefits Managers (PBMs) on their daily practice. In 2021, the Tennessee General Assembly passed Public Chapter 569, a comprehensive PBM reform bill. This legislation prohibited PBMs from discriminating against 340B pricing, patient steering (i.e., requiring patients to use a specified pharmacy), and under-reimbursement to pharmacies for their drug purchases. As countless pharmacists have seen, this legislation has been left unenforced by the Tennessee Department of Commerce and Insurance (TDCI).
Today, the Tennessee House Standing Committee on Insurance hosted a discussion on PBMs. The Committee members heard from Tennessee Pharmacists Association (TPA) leaders, as well as other representatives from the Tennessee healthcare community, about the limited enforcement of Tennessee’s PBM laws. At the hearing, TPA Executive Director Anthony Pudlo shared the role of PBMs in the pharmacy industry and how PBMs continue to be unregulated, despite the codification of Public Chapter 569. He stated, “I want to emphasize the frustration of thousands of pharmacists in this state who continue to see the failure of PBMs in complying with state law. Since Public Chapter 569 took effect, TPA has heard how complaints filed against PBMs to the Department of Commerce and Insurance go unresolved, as PBMs state their company is not based in Tennessee and therefore is not bound by Tennessee law, or their plan is self-insured and not within the jurisdiction of the law.”
The Committee also heard from TPA member and independent pharmacy owner Raewyn Snodderly of LaFollette, TN, who spoke about the constraints and financial stress that PBMs’ practices have brought to her ability to own a business while continuing to care for her patients. She described the thousands of dollars she loses every year in not only under-reimbursement, but also in losing patients to PBM-affiliated pharmacies due to the requirements of PBMs. She referenced how “the anti-competitive nature of the relationship is unbearable. We are provided take-it-or-leave-it contracts, we are not allowed in some networks or are not preferred, [and] my patients receive letters telling them to go to other pharmacies.”
TPA will continue to work with a broad coalition of stakeholders with the goal to regulate PBMs and provide safe and effective patient care. From the lack of appropriate drug reimbursements to mandating mail order delivery, the actions of these unregulated middlemen are unprecedented, and the consequences for pharmacists are crippling. TPA unwaveringly supports its members and the work of pharmacy teams as they seek overdue action to bring enforceable, legal regulation to the practices of PBMs.
# # #
About the Tennessee Board of Pharmacy
The Tennessee Pharmacists Association represents the profession of pharmacy across the state, united for the purpose of promoting safe and effective medication use to improve the health of patients. Since 1886, the Tennessee Pharmacists Association has preserved and advanced the interests of the profession and has served the professional needs of all pharmacists, student pharmacists, and pharmacy technicians.
Members of the media are invited to contact:
Anthony Pudlo, Executive Director