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Auditor McGuiness Supports Federal Legislation to End PBMs’ Predatory Practices

APha, NCPA, AOA logos

DOVER, Del. – State Auditor Kathy McGuiness has supported the National Community Pharmacists Association (NCPA) as it pushes for federal legislation to address pharmacy benefit managers’ (PBMs) predatory practices.

“It is heartrending to watch people have to decide between paying for their life-saving medications and buying food for their families,” McGuiness said. “It’s especially painful to see when you know that their prescription drug prices are being artificially inflated to line the bloated pockets of CVS, Express Scripts Inc. and OptumRx.”

McGuiness, a licensed immunizing pharmacist, has released two special reports so far on the impact that PBMs are having in Delaware. These reports – titled “Lack of Transparency & Accountability in Drug Pricing Could be Costing Taxpayers Millions” and “Predatory Practices: Survey Says Middlemen Destroying Delaware’s Independent Pharmacies” – have garnered national attention and helped to shine a light on how PBMs have overcharged Delaware taxpayers by millions of dollars.

Through predatory practices such as Direct and Indirect Remuneration (DIR) fees and spread pricing, PBMs are strangling independent pharmacies’ ability to stay open and serve as the first line of defense when their customers are hurt or sick.

“This is a critical issue that affects the lives of all Delaware residents,” McGuiness said. “That’s why I sent a letter to President Biden and Delaware’s federal delegation – Senators Tom Carper and Chris Coons, and Representative Lisa Blunt Rochester – asking them to support federal legislation to curb these harmful PBM practices.”

NCPA CEO B. Douglas Hoey, MBA, a pharmacist, thanked McGuiness for her support.

“Pharmacy DIR fees and spread pricing policies are among the most egregious PBM tactics we know of. This is an excellent moment for Congress and the Biden administration to end these ploys once and for all,” Hoey said. “We’re grateful to Auditor McGuiness for her important work on this and in fighting more broadly for increased PBM transparency and reforms.” 

The American Pharmacists Association (APhA) also said it supports national movements to regulate PBMs.

“Unique among any other party in health care, pharmacy benefit management companies are accountable to no one in how they conduct their business,” said APhA Executive Vice President and CEO Scott Knoer, also a pharmacist. “As a result, prescription drug costs are artificially high, generating inflated profit margins for the PBMs. This threatens patients’ access to pharmacists’ care in local communities. 

“APhA supports state and federal legislation and regulations that brings transparency to their clandestine activities and holds them more accountable.”

McGuiness has been a staunch advocate for raising public awareness of PBMs – and for demonstrating to legislators that healthcare is a critical issue for everyone.

“I will continue the fight to ensure taxpayer dollars are used efficiently, effectively and as intended,” McGuiness said, “and to protect Delaware’s residents from fraud, waste and abuse of their money.”

Learn about the Delaware Auditor’s Office at



Anna Nuzzolese, Executive Assistant