With shoppers already trusting their primary grocery store as an ally in health, pharmacies are another way for retailers to support consumers by enhancing the proposition of total store wellness.
In February 2020, FMI filed an amicus brief in the U.S. Supreme Court case, Rutledge v. Pharmaceutical Care Management Association in support of the State of Arkansas.
The Case: The issue before the Court in Rutledge v. Pharmaceutical Care Management Association considers whether a preemption provision in the federal ERISA statute permits states to enact legislation that governs practices of PBMs.
Our Position: FMI supports the Arkansas statute that the Supreme Court is reviewing, 2015 Arkansas Act 900 (“Act 900”) and similar laws. This legislation protects public access to health care through pharmacies without altering the uniform administration of ERISA plans. Our brief focuses on two points: First, laws like Act 900 are needed to limit how PBMs abuse their concentrated market power, which threatens patient access to pharmacies. Second, this legislation, Act 900, does not interfere with the uniform administration of ERISA plans, which is incredibly important to a variety of FMI members with employees living or working in more than one state.
Timeline: Oral arguments before the Court are slated for April 27, 2020. Brief of FMI and 23 Retail Trade Associations as Amici Curiae in support of petitioner
Direct and Indirect Remuneration fees, or DIR fees, were created with Medicare Part D, a prescription drug benefit program for elderly and disabled beneficiaries, to serve as a way for pharmacy benefit managers (PBMs) to report manufacturer rebates, so the federal government would be able to account for actual drug costs. Think of PBMs as the middlemen between health insurance companies and pharmacies. They serve as third-party administrators of prescription drug programs for commercial, self-insured, Medicare Part D and state/federal employee health plans.
According to the federal government, DIR fees have increased by 45,000% in less than ten years. Therefore, patients are facing higher out-of-pocket costs while pharmacies are struggling to stay in business.
The bipartisan Phair Pricing Act of 2019 (H.R. 1034 / S. 640) would make all of the criteria for reimbursement determined at the point of sale, assuring that Medicare patients are properly charged and defending pharmacies from the financial uncertainties they currently face.