The proposed legislation, the Inflation Reduction Act of 2022, aims to do three things: limit copays for Medicare and Medicaid recipients, force drugmakers to pay Medicare if their prices exceed inflation rates by 2023, and allow the federal government to negotiate drug prices by 2026. The bill was formerly part of President Joe Biden’s Build Back Better Bill, which has stumbled for months as legislators chipped away at it.
The APCI applauded the efforts but said the government needs to add restrictions for pharmacy benefit managers, the middlemen between insurers and payers that have been criticized for years for their hidden business practices. In response to these allegations, the FTC recently opened an investigation into six PBMs, including CVS Caremark and Humana, that make up a large majority — 98 percent — of the PBM industry.
A few of the proposed add-ons from the APCI include laws to “reform Medicaid managed care including prohibiting PBM spread pricing” and “rein in abusive PBM practices and implement a transparent drug pricing model in Medicare Part D.”
Without these add-ons, the pharmaceutical group said the legislation would “disregard a major flaw in our healthcare system.”
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