Collins, Loebsack Introduce Generic Drug Pricing Fairness Act

Press Release

As part of the ongoing effort to bring both access and transparency to the Medicare prescription drug programs, Congressman Doug Collins (GA-09) and Congressman Dave Loebsack (IA-02) have introduced H.R. 4437, the Generic Drug Pricing Fairness Act.

H.R. 4437 would make fair and transparent the process of reimbursement by MAC lists. Maximum Allowable Cost (MAC) lists set forth the maximum amount a Pharmacy Benefits Manager will reimburse a pharmacy for any generic drug. Because Pharmacy Benefit Managers often use multiple MAC lists, pharmacies of every size and affiliation are faced with uncertainty about how much they'll be reimbursed and what generic drugs are even covered. As a result, pharmacies are kept in the dark and forced to live under "take-it-or-leave-it" contracts without any idea of what the reimbursement price will be for generic drugs. Through these transparency reforms, pharmacies can better negotiate contract proposals with PBMs and ensure they are a lasting fixture in our communities and neighborhoods.

This legislation also would make it clear how the MAC lists were determined, when they were updated, and how they might be appealed if a dispute arises over payment levels. Significantly for community pharmacies, the Generic Drug Pricing Fairness Act would also compel programs to disclose if different MAC lists are being used to generate profit through deceptive practices, such as using one list to reimburse their contracted pharmacies and different list to sell the drugs to the clients of plan sponsors.

Congressman Collins said: "A pharmacist often must provide crucial, very personal reassurance to their customers. A pharmacist can't provide certainty to a patient if they're operating with this kind of uncertainty about how much they'll have to pay for their stock. This is something we can do to create transparency and fairness in how prescription drugs reach customers--our constituents."

Congressman Loebsack added, "I have personally met with many Iowa pharmacists, and I have heard time and time again their frustrations with the unpredictability of reimbursement for generic drugs. In order for our local, community pharmacies to continue to provide quality service to our seniors, we must ensure that pharmacists have accurate, up-to-date information about drug pricing. This is critical to maintain access to affordable drugs for seniors, many of whom are on fixed incomes and face high health care costs."

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