Focus on PBM Reform: Expanding ACCP’s Coalition to Advance Coverage for Medication Management Services

When Congress returns to Washington for a “lame-duck” session after the November midterm elections, there is a brief window on the legislative calendar, and lawmakers face an urgent “to-do” list before the new congressional members are sworn in in January.

Given this compressed time schedule, it is widely expected that Congress will try to coalesce around an end-of-the-year legislative package that could include mental health enhancements, further changes at the FDA, telehealth policy updates, and regulatory updates affecting the pharmaceutical supply chain that could overhaul the marketplace for pharmacy benefit managers (PBMs).

ACCP believes that any reform of the PBM structures must include robust patient care provisions that would provide coverage for patients to access meaningful medication management services delivered by team-based clinical pharmacists. Buried in a policy document that House Republican leadership shared with ACCP is a commitment to expanding access to advanced payment initiatives such as direct contracting, high-performance networks, and centers for excellence for purchasing health care.

After conversations with health policy staffers on Capitol Hill, ACCP is developing a strategy to partner with employers, providers, patients, and other stakeholders to change the dynamics of the PBM industry and reorient PBMs to integrate patient-focused, value-added services, including comprehensive medication management (CMM).

ACCP has already been engaged through the “Buy Right Strategy” of the Get the Medications Right (GTMRx) Institute to develop a dialogue with America’s major employers, who collectively sponsor health benefits for more than 160 million Americans and pay billions of dollars for prescription drug coverage, yet typically have very limited insight into the effectiveness of their drug benefit programs and the outcomes they produce on behalf of patients.

GTMRx developed an employer toolkit in April to engage with representatives from some of the nation’s largest employers on key policy areas:

• Understand why the current system of trial-and-error medication use must change in order to eliminate the waste it creates.
• Understand how comprehensive medication management (CMM) is being used today to effectively transform and optimize medication use while achieving measurable, positive treatment outcomes that improve lives and save money (CMM 10-step process).
• Grasp the value equation for employer advocacy and leadership of system transformation through CMM.
• Recognize why employers should be key leaders of change and the actions that will establish them as market leaders and champions of transformation to avoid medication overuse, underuse, and misuse.
• Take action to become leaders of change. The current ineffective and often harmful system must transform to one that facilitates optimal medication use and delivers desired clinical outcomes for all Americans as quickly and cost-effectively as possible.

Click here to read more about the GTMRx Buy Right Strategy – an educational outreach program to educate employers as health plan sponsors about a better way to manage medications.

Take Action!

If Congress is serious about reforming the PBM industry, key stakeholders – including pharmaceutical manufacturers, major employers, and PBMs themselves – are expected to engage in a fierce, well-funded media and lobbying campaign.

Now is the perfect time for ACCP members to raise awareness about optimizing medication use on behalf of patients. It is vital that elected officials hear from clinical pharmacists delivering direct patient care services in their state or district to learn firsthand about the value they bring to the medication optimization process.

Contacting the offices of your elected officials is simple. ACCP has prepared a letter for you to review and edit. Simply follow the instructions to send this message to Capitol Hill.

Please take the time to personalize the letter by providing additional information about your practice and the patients you care for. If appropriate, highlight what the COVID pandemic has meant for your practice and your patients. Click here to take action today!