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.
