PBM Bill Mark Up Paves Way for Full Chamber Consideration

The Senate Finance Committee has advanced a bill seeking to reform pharmacy benefit managers (PBM) by prohibiting them from deriving compensation for Medicare Part D-covered drugs based on the drug’s list price, among other proposals.

“This set of proposals is squarely aimed at addressing practices by drug middlemen that are driving up health costs for patients and taxpayers,” said Chair Ron Wyden (D-Ore.) ahead of the committee mark-up, while Ranking Member Mike Crapo (R-Idaho) stated that this “package comprises a strong set of bipartisan, patient-focused proposals aimed at fueling competition, improving transparency, and mitigating misaligned incentives in Medicare Part D and Medicaid.”

The Modernizing and Ensuring PBM Accountability Act, which seeks to lower the cost of prescription drugs and provide taxpayer savings of approximately $1.7 billion, would also ban spread pricing in Medicaid plans. This practice occurs when PBMs simultaneously negotiate a lower pharmacy price but charge an insurer a higher price, keeping the difference.

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