Pharmacy benefit managers (PBMs) are the intermediaries who negotiate discounts with drug companies on behalf of insurance plans.
Last month, the Senate Commerce Committee cleared a bipartisan bill aimed at eliminating the practice of “spread pricing,” which is when a PBM charges a payer like Medicaid more for prescription drugs than they pay the pharmacy, and then keeps the difference as profit.
A similar bipartisan bill was introduced in the House, and House Oversight Committee Chairman James Comer (R-Ky.) launched an investigation into the industry.
Last week, bipartisan leaders of the Senate Finance Committee released legislative framework of a PBM reform bill, with the aim of putting out a bill this summer. The lawmakers said they want to focus on issues like transparency and making sure PBMs pass on meaningful savings to consumers.
And Senate HELP Committee Chairman Bernie Sanders (I-Vt.) announced a hearing featuring executives from the major PBMs: CVS Health, Express Scripts and OptumRX.
Sanders has long been a critic of pharmaceutical companies, but the inclusion of the PBM industry leaders signals a new front in his drug pricing fight.
Drugmakers blame PBMs for the high costs of prescription drugs, though the industry says their role is misunderstood and executives point fingers at the manufacturers.
The PBMs argue they can negotiate with insurers and manufacturers for lower drug costs and larger discounts for medications. They pass savings on to insurance plans, resulting in lower premiums for consumers.
With the Inflation Reduction Act provisions targeting manufacturers now law, lawmakers see the PBM industry as ripe for reform.
But even with bipartisan support, it’s unclear how much progress there will be with such a deeply divided Congress.
