House members uncertain PBM reform will pass this session

Two House lawmakers expressed uncertainty Wednesday on when pharmacy benefit manager (PBM) reforms would pass, despite widespread bipartisan support for some sort of action on the health care middlemen.

Reps. Jake Auchincloss (D-Mass.) and James Comer (R-Ky.) spoke with The Hill’s Editor-in-Chief Bob Cusack on Wednesday as part of the “Prescribing PBM Reform” event hosted by Transparency-Rx.

Congressional funding bills unveiled earlier this week left out reforms for PBMs. Auchincloss said Wednesday he believed action on the issue could happen before a lame-duck session after November’s election, but he had doubts.

“It could be done beforehand. Some of those decisions are happening in rooms, frankly, that I’m not invited to,” he said. “I would just have a baseline expectation that it’s gonna be very hard to pass policy in the 118th Congress where we’ve got an incompetent Speaker … in an election year going into an election.”

The congressman pointed to the Tax Relief for American Families and Workers Act that passed through the House with bipartisan support but “deflated in the Senate,” saying that conditions in Congress are “very unwieldy right now.”

Comer agreed with Auchincloss, saying some movement on PBM reform could occur before the end of the year. Comer was quick to note that the Oversight and Accountability Committee that he chairs advanced an anti-price gouging bill for federal employee health benefits programs.

“Whether it’s been a Democrat majority or a Republican majority, Congress talks about this issue all time but nobody ever does anything,” Comer said. “And I honestly don’t know why. Everyone is ‘Oh, you know why.’ I say I really don’t know why. I don’t know why. And I think that there just has to continue to be a groundswell of support for this.”

“Shame on Congress for not doing more already. And that that goes to both sides of the aisle,” he added.

The Pharmaceutical Care Management Association (PCMA), which represents PBMs, said it was “disappointing” that neither the group nor any of its members were invited to participate in Wednesday’s discussion.

“No mention of how PBMs support transparency that empowers prescribers, plan sponsors, policymakers, and, most importantly, patients, with the information they need to lower costs while improving access to needed medications, leaves everyone with an incomplete picture of how the system actually works,” Greg Lopes, PCMA spokesperson, said in a statement.

“If lawmakers and stakeholders want to effectively lower drug costs for the American people, having one-sided conversations that fail to address the elephant in the room – Big Pharma’s anti-competitive tactics that are the root cause of high prescription drug prices – and ignore the numerous analyses that underscore the immense savings from pharmacy benefit companies and the real consequences for patients and families if proposals targeting Americans’ pharmacy benefits are implemented, is counterproductive.”

The White House on Monday held a listening session with industry representatives on how to enact changes that would make the PBM industry more transparent.

President Biden is expected to call on Congress to take stronger action on drug pricing in his State of the Union address Thursday. According to White House officials, Biden will call on Congress to expand on the Medicare cost-lowering measure enacted through the Inflation Reduction Act.

When asked if he would like Biden to speak on PBM reforms in his upcoming address, Auchincloss said he doesn’t want the president to “commit to things that he’s totally dependent on Congress to do.”