Here are four things to know:
- A House Energy and Commerce subcommittee held a hearing Feb. 26 to discuss potential legislative solutions aimed at reducing the PBM influence over drug costs.
- Three of the top PBMs — CVS Caremark, Cigna Express Scripts and UnitedHealth’s Optum Rx — control 80% of U.S. prescriptions, which has raised concerns about anti-competitive practices that could drive up drug costs for patients and independent pharmacies.
- Lawmakers are targeting spread pricing, which is the difference between what a PBM reimburses a pharmacy and what it charges an insurance plan’s sponsor, as well as considering requiring PBMs to pass 100% of rebates to pharmacies, with the intent of lowering the costs for consumers.
- The Pharmaceutical Care Management Association argued that PBMs are already adapting to provide greater transparency and lower out-of-pocket costs, while critics said they drive up prices through vague pricing tactics, according to WBFF.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.