In a 160-page bill introduced May 11, House Republicans proposed requiring pharmacy benefit managers to adhere to a transparent pass-through pricing model with states.
If the bill — which aims to cut billions of dollars in Medicaid funds — passes, federal law would require:
1. Contracts between PBMs and states to adhere to a drug pricing model limited to a therapy’s ingredient cost and dispensing fee.
2. Payments to be passed in their entirety by the PBM to the pharmacy or dispenser.
3. PBM administrative fees to reflect fair market value.
Medications covered under the 340B program are excluded. Additionally, spread pricing in the form of “post-sale or post-invoice fees, discounts or related adjustments such as direct and indirect remuneration fees or assessments” would not be allowed.
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