Senate
Finance
Committee
Chairman
Mike
Crapo
(R-Idaho)
and
Ranking
Member
Ron
Wyden
(D-Oregon)
introduced
a
bill
Thursday
that
aims
to
bring
more
transparency
into
the
practices
of
pharmacy
benefit
managers.
PBMs
have
come
under
a
lot
of
scrutiny
in
recent
years
due
to
their
vertical
integration
with
insurers
and
practices
that
inflate
drug
prices.
The
top
three
PBMs
—
CVS
Caremark,
Cigna’s
Express
Scripts
and
UnitedHealth
Group’s
Optum
Rx
—
control
about
80%
of
the
prescription
drug
market.
The
bill,
titled
the
PBM
Price
Transparency
and
Accountability
Act,
would
delink
PBM
compensation
from
negotiated
rebates.
This
would
disincentivize
PBMs
from
promoting
higher-priced
drugs.
It
would
also
increase
reporting
requirements
for
PBMs
to
Medicare
Part
D
plan
sponsors
and
HHS,
as
well
as
help
plan
sponsors
audit
their
PBMs.
In
addition,
it
would
strengthen
requirements
that
plan
sponsors
contract
with
any
willing
pharmacy
that
meets
standard
terms
to
protect
rural
independent
pharmacies
from
harmful
practices
and
closures.
It
would
also
mandate
retail
community
pharmacies
to
participate
in
the
National
Average
Drug
Acquisition
Cost
(NADAC)
survey
to
ensure
more
accurate
Medicaid
reimbursement
rates.
Lastly,
PBMs
would
be
required
to
pass
Medicaid
payments
directly
to
pharmacies
so
that
there
is
more
transparency
in
drug
costs
for
states
and
taxpayers.
“Pharmacy
benefit
managers
should
not
profit
from
overcharging
patients
for
their
prescriptions,”
said
Crapo
in
a
statement.
“This
bipartisan
legislation
is
a
decisive
step
toward
making
the
prescription
drug
market
easier
to
navigate
for
both
patients
and
pharmacies.
These
proposals
form
a
strong
foundation
for
additional
efforts
to
promote
pharmacy
access,
demystify
drug
pricing
and
reduce
costs
for
both
taxpayers
and
seniors.”
Wyden
echoed
these
comments.
“It’s
long
past
time
to
go
after
middlemen
who
are
making
Americans’
prescription
drugs
more
expensive,”
he
said.
“The
Finance
Committee
has
put
forward
a
comprehensive
approach
to
stop
the
pharmacy
benefit
manager
business
practices
that
are
harming
seniors
and
taxpayers
who
count
on
Medicare
to
deliver
affordable
prescription
drugs.
It’s
time
to
get
this
done.”
The
bill
was
co-sponsored
by
19
additional
senators,
including
John
Barrasso
(R-Wyoming),
Michael
Bennet
(D-Colorado),
Marsha
Blackburn
(R-Tennessee),
Catherine
Cortez
Masto
(D-Nevada)
and
Bill
Cassidy
(R-Louisiana).
Numerous
efforts
have
been
attempted
to
rein
in
pharmacy
benefit
managers,
though
few
have
actually
come
to
fruition.
For
example,
last
year,
the
federal
government
almost
passed
a
spending
bill
that
would
have
cracked
down
on
PBMs,
but
this
provision
was
taken
out
at
the
last
minute.
States
have
also
taken
their
own
steps.
California
recently
passed
a
law
that
will
regulate
PBMs.
Arkansas
also
passed
a
law
that
would
ban
PBMs
from
owning
pharmacies,
but
a
federal
judge
has
blocked
this
from
being
enacted.
Photo:
Stas_V,
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