A bipartisan coalition of legislators, led by the leaders of the Senate Finance Committee, has reintroduced a major pharmacy benefit manager (PBM) regulation bill in Congress. Sen. Mike Crapo, R-Idaho, Senate Finance Committee chairman, and Sen. Ron Wyden, the highest-ranking Democrat on the committee, have introduced the “PBM Price Transparency and Accountability Act” bill in conjunction with a bevy of Republican and Democratic cosponsors. Additionally, both the National Community Pharmacists Association and the National Association of Specialty Pharmacy have expressed support for the bill.
Among the highlights of the bill are the following:
- PBMs are subject to detailed reporting requirements if they work with Medicare Part D prescription drug plans.
- PBMs serving Medicaid plans must pass Medicaid payments directly to pharmacies.
- Public health plans must allow patients to use any pharmacy that meets the plans’ standard contract terms.
A notable exclusion from the bill is any mention of PBMs that employer-sponsored health plans utilize. The previous version of the PBM bill included provisions addressing PBMs and employer-sponsored health plans. That incarnation of the bill would have required PBMs serving large fully-insured employer health plans or self-insured employer health plans to pass along 100% of any drug rebates or discounts to the plan sponsor. The bill also would have required significant reporting requirements for PBMs.
The public health PBM bill also appeared as a bipartisan-supported provision in the congressional continuing resolution deal that was supposed to avoid a federal government shutdown. Nonetheless, Congress ended up gutting both the public and employer PBM provisions from the final version of the continuing resolution that President Donald Trump ultimately signed into law.
The reemergence of the PBM bill for public healthcare plans could signal a wave of new healthcare legislation. Other potential PBM-related bills could address employer-sponsored plans and PBM usage, health accounts, and other bills that have solid bipartisan support. Republicans also appeared to insinuate that PBM legislation would soon pass via an alternative route.
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