Rep.
Earl
L.
“Buddy”
Carter
(R-Georgia)
introduced
the
PBM
Reform
Act
last
week,
which
seeks
to
crack
down
on
pharmacy
benefit
manager
(PBM)
practices.
The
bill
has
bipartisan
support
and
was
co-sponsored
by
Representatives
Debbie
Dingell
(D-Michigan),
Greg
Murphy
(R-North
Carolina),
Deborah
Ross
(D-North
Carolina),
Jodey
Arrington
(R-Texas),
Diana
Harshbarger
(R-Tennessee),
Vicente
Gonzalez
(D-Texas),
Rick
Allen
(R-Georgia),
Raja
Krishnamoorthi
(D-Illinois),
John
Rose
(R-Tennessee),
Derek
Tran
(D-California),
and
Nicole
Malliotakis
(R-New
York).
The
bill
will
ban
spread
pricing
in
Medicaid.
This
is
when
a
PBM
charges
payers
more
than
they
pay
the
pharmacy
for
a
medication
and
then
keeps
the
difference
as
profit.
It
also
seeks
to
“delink”
PBM
compensation
from
the
cost
of
medications
under
Medicare
Part
D.
In
addition,
it
will
require
semi-annual
reporting
on
drug
spending,
rebates
and
formulary
determinations.
It
will
also
mandate
that
the
Centers
for
Medicare
and
Medicaid
Services
enforce
“reasonable
and
relevant”
contract
terms
in
Medicare
Part
D
pharmacy
contracts
and
address
violations.
The
introduction
of
the
bill
comes
as
the
big
three
PBMs
—
CVS
Caremark,
UnitedHealth
Group’s
Optum
Rx
and
Cigna’s
Express
Scripts
—
control
80%
of
the
prescription
drug
market.
“It’s
time
to
bust
up
the
PBM
monopoly,
which
has
been
stealing
hope
and
health
from
patients
for
decades.
As
a
pharmacist,
I’ve
seen
how
PBMs
abuse
patients
firsthand,
and
believe
that
the
cure
to
this
infectious
disease
is
transparency,
competition,
and
accountability,
which
is
exactly
what
our
bipartisan
package
provides,”
Carter
said
in
a
statement.
Carter’s
comments
were
echoed
by
Dingell
of
Michigan.
“For
too
long,
pharmacy
benefit
managers
have
been
allowed
to
operate
unchecked,
raising
prices
and
preventing
many
patients
from
getting
the
medications
they
depend
on,”
Dingell
said
in
a
statement.
“I
hear
from
too
many
Michiganders,
especially
seniors,
who
can’t
conveniently
access
the
prescriptions
they
need,
due
to
exploitative
PBM
practices
complicating
access
to
their
local
pharmacies.
Their
harmful,
aggressive
tactics
are
only
getting
worse,
and
we
must
take
action
now
to
protect
pharmacies
and
lower
patient
costs.
I
remain
committed
to
working
with
my
colleagues
on
both
sides
of
the
aisle
to
get
this
across
the
finish
line.”
Numerous
other
efforts
have
been
taken
targeting
PBMs.
The
state
of
Arkansas
recently
created
a
law
banning
PBMs
from
owning
and
operating
pharmacies
in
the
state,
prompting
CVS
Caremark
and
Express
Scripts
to
file
separate
lawsuits
challenging
the
law.
In
December,
Senators
Elizabeth
Warren
(D-Massachusetts)
and
Josh
Hawley
(R-Missouri)
introduced
a
bipartisan
bill
that
would
also
ban
PBMs
from
owning
pharmacies.
Photo:
z_wei,
Getty
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