Senate would unlink PBM bill fees, exempt drug prices

Pharmacy benefit managers would not be allowed to factor fees, pharmaceutical company rebates and other costs into prescription drug prices for Medicare Part D plans under bipartisan Senate legislation introduced Wednesday.

The Patients Before Middlemen (PBM) Act of 2023, sponsored by Sens. Robert Menendez (DN.J.) and Marsha Blackburn (R-Tenn.), has garnered the support of Finance Committee Chairman Ron Wyden (D-Ore.) and . Ranking members are Mike Crapo (R-Idaho), Sen. Jon Tester (D-Mont.) and Sen. Dr. Along with Roger Marshall (R-Kan.). Wyden and Crapo have not scheduled a hearing or markup for consideration of the bill.

“Pharmacy benefit managers rig the system to maximize profit while doing little to reduce the cost of prescription drugs for patients over the pharmacy counter,” Menendez said in a news release. By delinking beneficiary PBM compensation from list prices and utilization levels – perpetuating a perverse incentive structure that has done nothing but harm patients.”

The Menendez-Blackburn measure emerged from the Finance Committee’s prior work on PBMs and drug prices, such as the Legislative Framework panel unveiled in March.

“This legislation will stop one of the most aggressive practices driving the price of prescription drugs in Medicare: pharmacy benefit managers being paid based on the cost of the drug,” Wyden said in the news release.

The Pharmaceutical Care Management Association, which represents PBMs including Cigna subsidiary Express Scripts, CVS Health subsidiary CVS Caremark and UnitedHealth Group subsidiary OptumRX, blasted the bill.

“While we are currently reviewing the legislation, it is clear that it fails to address the root cause of high prices and appears to buy into the false rhetoric and self-serving agenda of big drug companies. Companies, not pharmacy profit companies, are “set and fueled by the high list prices they single-handedly,” said the for-profit Pharmaceutical Care Management Association. “Pharmacy profit companies are compensated on the basis that they generate savings for employers, patients and taxpayers.” how effectively they protect the drug – serving as the only real check against the otherwise limitless pricing power of drug companies.”

The Finance Committee is the latest congressional panel to target PBMs this year. Senate Health, Education, Labor and Pensions Committee approved law last month that, among other things, would bar pharmacy benefits managers from engaging in lucrative practice of spread pricing, and the House Energy and Commerce Committee move one step forward Last month Joe will impose strict new transparency rules on PBMs. in addition House Oversight and Accountability Committee And federal trade commission Checking out the industry.

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