Seven PBM bills wading through Congress

At least seven federal bills looking to trim the scope of pharmacy benefit managers are trudging through the legislative process. Here's where they stand as of May 1: 

  • The Pharmacy Benefit Manager Reform Act, which seeks to curb spread pricing and increase oversight on PBMs, was introduced April 27. The Senate Health, Education, Labor and Pensions Committee plans to mark up this bill May 2. 

  • Two senators introduced the Drug Price Transparency in Medicaid Act April 4. The bill looks to require Medicaid payments to PBMs to be passed directly to pharmacies, excluding administrative fees, and mandate pharmacies part of their state's Medicaid program to be transparent with National Average Drug Acquisitions Costs. It has been referred to the Committee on Health, Education, Labor and Pensions. A copy is in the House's energy and commerce committee. 

  • Lawmakers reintroduced the Prescription Pricing for the People Act and the Pharmacy Benefit Manager Transparency Act on Jan. 26. The former would require the Federal Trade Commission to study consolidation in the PBM industry and is in the Senate's judiciary committee. The latter looks to ban PBMs from reimbursement clawbacks and other practices deemed deceptive and is in the Commerce, Science and Transportation committee. 

  • The Pharmacy Benefits Manager Accountability Act, introduced April 18, seeks to mandate payers issue annual reports on drugs accessed through PBMs and their copayment amount and "total gross spending on prescription drugs … before rebates and other manufacturer fees." The bill has been referred to three House committees.

  • The PROTECT 340B Act, or the Preserving Rules Ordered for the Entities Covered Through 340B Act, looks to prevent PBMs from adjusting eligible pharmacies for a federal drug pricing program. It was introduced April 6 in the House and has been referred to three House committees.

After failing to block the Inflation Reduction Act from passing in 2022, it's unclear how successful these bills will be as pharma lobby groups and trade associations, such as the Pharmaceutical Care Management Association, work against these efforts. 

"While we should absolutely focus on ensuring fewer patients fall through the cracks when it comes to affordability and access, we can't lose sight of the fact that our system is working for so many others," PCMA CEO JC Scott said April 25 during a policy forum, according to Roll Call. "Because if we do lose sight of that reality, we run the risk of advancing legislation and regulation that undermines the health care system instead of improving it."

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