Legislation moving through state capitals and in Washington could lead to increased payments for drugstore chains like CVS Health, Walgreens, Walmart, and independent pharmacies nationwide. While pharmacies did not receive the desired outcome from Congress in a recent spending package, the potential for legislation benefiting pharmacies and regulating pharmacy benefit managers (PBMs) remains high.
The National Community Pharmacists Association has emphasized the urgent need for PBM reform, with support from both parties and incoming and outgoing presidents. The impact of PBMs on pharmacies has been significant, with many attributing closures to reimbursement challenges from these entities. PBMs act as intermediaries between drug companies and consumers, influencing payment rates for pharmacies dispensing prescription medications.
Recent scrutiny of PBMs has prompted a push for regulatory changes, with an increasing number of states considering measures to boost pharmacy payments. Executives in the industry acknowledge the impending shift in regulations, foreseeing changes in practices and oversight from federal and state governments.
Proposed provisions in Congress aim to ensure fair reimbursement for pharmacies in Medicaid managed care programs, potentially saving taxpayers billions over the next decade. While the financial implications for CVS, which owns a PBM, remain uncertain, other regulations advancing in states could benefit pharmacists and retail pharmacies under CVS ownership and beyond.
In addition to payment reforms, states are also expanding the role of pharmacists to include prescribing certain medications. This “test to treat” legislation grants pharmacists prescribing authority, enabling them to diagnose and treat various conditions on-site.
At the recent Forbes Healthcare Summit, Walgreens’ chief pharmacy officer, Rick Gates, highlighted the evolving role of pharmacists in healthcare. Pharmacists are now conducting tests for illnesses like Covid-19 and initiating treatment plans, showcasing the potential for pharmacies to play a more significant role in patient care.
As the landscape of pharmacy regulation continues to evolve, stakeholders are bracing for changes that could reshape the industry and improve access to care for patients nationwide.
