Not Going Back to Business as Usual: How HR 9096 Made Activist-Lobbyists Out of Pharmacists

The following is an excerpt from a forthcoming article in Dispense magazine, authored by PUTT Executive Board member Jeremy Counts:

Typically summer is slow for advocacy, but not Summer 2024. Notable events included The New York Times publishing an article on PBM abuse; 3 Axis Advisors releasing its long-awaited report on independent pharmacy underpayments and PBM self-dealing; and the FTC unveiling the interim 6B study detailing PBM anti-competitive practices — all in the same week. That July Rep. James Comer would release the House Oversight Committee’s damning investigative report on PBMs; “Big 3” PBM executives would testify (and lie) before the House Oversight Committee, and Rep. Comer would go on to issue clemency letters to those Big 3 executives, offering the opportunity to “correct” their testimony, only to watch those Big 3 executives double down on their perjury.

And yet, even with such notable activities, the pivot point would be PUTT’s annual Summit in July where a federal Congressman named Jake Auchincloss would help us collectively fire the shot over the bow that has now and forever changed how PUTT advocates and why we will not go back to the old way of doing things.

The Summer the Pharmacists Fight Back … Starting at the PUTT Summit

PUTT’s annual Summit brings pharmacists/pharmacy owners, patient advocates and state legislators together for real-time strategic discussion and the latest PBM reform updates.

I was on family vacation that week and hardly able to sleep with anticipation. I was scheduled to present a breakdown of the 3 Axis Advisors’ latest study (“Understanding Drug Pricing From Divergent Perspectives”) at the Summit, but truthfully I was anxiously awaiting the release of a new federal bill that contained provisions that would finally address our most pressing issues.

That bill would be HR 9096, The Pharmacists Fight Back Act, and it was a good 18 months in the making. Spearheaded by Greg Reybold, who had long worked to bring meaningful PBM reform legislation to Congress, his efforts paid off when Massachusetts Congressman Jake Auchincloss (D-MA) expressed interest in the cause.

Representative Auchincloss is bright, aggressive, and knowledgeable of the pharmacy industry. He possesses an in-depth understanding of the pharmacist’s experience with PBM abuse, PBM underhanded tactics and PBM deception. Basically, he was born to champion The Pharmacists Fight Back Act.

And like PUTT, the Congressman doesn’t hesitate and doesn’t back down from a challenge. Teaming with Rep. Diana Harshbarger (R-TN), a pharmacist, the Representatives timed HR 9096’s introduction with the Oversight Committee hearing, the NYT article, the 3 Axis study and the FTC interim report. They stressed the urgent need for PBM reform NOW.

And so the aptly named Pharmacists Fight Back Act was filed and Congressman Auchincloss announced the new bill at the PUTT Summit, with a single request: help him find 50 bill co-sponsors from both sides of the aisle.

It’s clear why we are determined to go all in to find cosponsors and see this bill made into law. The Pharmacists Fight Back Act has:

1. NADAC++ (yes, a second plus!) reimbursement for all federal and state plans

2. Prohibitions on PBM steering and exclusionary network design, retroactive fees, spread pricing, brand requirements, network metrics, and clawbacks.

3. A requirement that 80% of all PBM/GPO rebates and fees go toward reducing patients’ out of pocket expenses. The remaining 20% must be used to bring down patient premiums.

It is the granddaddy of all pharmacists’ wish lists, one that will box PBMs into paying pharmacies fairly. So if Auchincloss asked for 50 co-sponsors, we were ready to get to work.

Lies, Agendas and Territorialism

Getting a bill passed can be cutthroat as hell. There are the opposition lobbyists to deal with; “donor class” mavens on the pro-PBM bandwagon; even fears from within our own profession that new bills will somehow interfere with existing bills and thus void PBM reform all together.

Lies, agendas, and territorialism undermine bills that would otherwise make a real difference, Even if those bills would do something so obviously good for a legislator’s constituents.

We didn’t want that to happen, so we turned to the PUTT Action Network, a nexus of industry and political power players that includes friends old and new. Enthusiasm for HR 9096 quickly became a wave with the potential to push the other pharmacy bills to pass. It was something to ride, not to fight.

Pharmacy groups immediately jumped on board: the Virginia independent pharmacists joined the Kentucky Independent Pharmacists Association, the Louisiana Independent Pharmacies Association, the Massachusetts Independent Pharmacies, the Texas Indys, the Minnesota Independents (the MNIndys), the Wisconsin Independents, the Arizona Independents, and many more in a wide-spread calling and meeting campaign that today, so far, has resulted in 30 co-sponsors evenly divided between Democrats and Republicans on our way to 50.

Pharmacists everywhere are discussing and promoting HR 9096 and calling their lawmakers to get them on board. This has turned from a wave to a tsunami.

It’s Time: Be loud. Be fearless. Be Willing to Fight.

This summer we all witnessed something that many did not think was possible: pharmacists, patients, and physicians organized and mobilized against PBM abuse. It was a wake-up call that has sparked conversations while opening the door to more communication, coordination, and cooperation between the major players in pharmacy.

The window for change is open and our path forward is clear. We have our general in Rep. Jake Auchincloss and our battle plan to pass HR 9096. Now we must assemble to urge lawmakers to cosponsor The Pharmacists Fight Back Act.

We just need you. Even the smallest efforts build momentum in a big way. Take 5 minutes out of your day to contact your representative’s office and urge them to save community pharmacy by signing onto HR 9096. Or take it a step further: set a meeting with your representative to meet with local pharmacists so he/she can learn how important this bill is. Don’t worry if you don’t know exactly what to do or say, we at PUTT are ready to help you plan and craft a message that resonates. We’re here to empower you.

To get more directly involved, join us at PUTT where you can learn to effectively advocate, organize and/or donate to our PBM reform campaigns. The more people actively involved, the more we can collectively achieve.

This is our window. This is our time. This is how we save our profession.

Jeremy Counts is a pharmacist and owner of Counts Family Pharmacy in Blacksburg, Virginia. He is an Executive Board Member at Pharmacists United for Truth and Transparency and host of 2 podcasts. Follow Jeremy on X, Tik Tok, LinkedIn and Instagram.