Medicare Part D contract rates for specialty pharmacies for 2024 and 2025 are “abysmal,” said Julie Allen, a principal with Powers Law, who represents the National Association of Specialty Pharmacy (NASP).

“In some cases, we understand these contract rates have been so significantly below cost that pharmacies are unsure whether they can continue to dispense specific drugs any further, while meeting all contract terms,” Ms. Allen said at the NASP 2024 Annual Meeting & Expo, in Nashville, Tenn.

NASP is advancing language at the federal level that would enforce the Part D “any willing pharmacy” statute in a way that would ensure pharmacies have reasonable contract terms to participate in networks, including reasonable reimbursement. The language would be added to the pharmacy benefit manager (PBM) reform bills under consideration in Congress, Ms. Allen said. Other pharmacy priorities in the PBM reform bills include:

• eliminating spread pricing practices in Medicaid;
• ensuring that any metrics used to measure specialty pharmacy performance/quality are standardized and appropriate based on the drugs dispensed and services provided; and
• requiring plans/PBMs to provide pharmacies all payment information, so that any payments or adjustments are explained and fully transparent.

There are many different bills now at various stages of consideration on Capitol Hill tied to PBM reform, Ms. Allen noted. “There are a lot of cooks in the kitchen. We have at least eight committees, between the House and the Senate, that have weighed in on reform policies and a number of proposals that could advance in an end-of-year legislative package.”

As these efforts unfold, “what’s important is for pharmacies to convey to lawmakers the message that pharmacy protections must be passed in any PBM reform legislation that advances,” Ms. Allen stressed. “It’s important that pharmacy is beating this drum, because everyone else is beating their own in an effort to advance legislation this calendar year.”

At the state level, 25 pieces of legislation were introduced that attempt to define specialty pharmacy and/or specialty drugs, said Taryn Couture, the director of government relations at Powers Law. “This is an exponential increase from past years,” she said, adding that the increase was partly due to specialty pharmacy having been “a very easy target because it makes up a significant portion of drug spend.”

Most state legislative language attempts at least one of the following:

• clarifying which drugs should be dispensed by a specialty pharmacy;
• working to limit patient steering to PBM-affiliated specialty pharmacies; and
• addressing the costs of specialty drugs to state Medicaid programs.

Ms. Allen reported no relevant financial disclosures.