American Health Policy Institute

Senate Rolls Out Telemental Health and PBM Pricing Legislation

Bipartisan PBM legislation would prohibit certain PBM pricing schemes and improve transparency while a discussion draft on telehealth calls for expanding and extending telehealth benefits for Medicare participants. Separately, DOL announced it is open to providing more mental health parity guidance to employers.

The Pharmacy Benefit Manager Transparency Act, introduced by Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA), would:

  • Block PBMs from engaging in spread pricing, reducing or clawing back drug reimbursement payments to pharmacies, and charging pharmacies more to offset federal reimbursement changes;

  • Improve transparency by requiring PBMs to report the amount of money they obtain from spread pricing, pharmacy fees, and clawbacks, and whether and why they move drugs in formulary tiers to increase costs; and

  • Direct the FTC to report to Congress whether PBMs engage in unfair or deceptive formulary design or placement.

The Telemental Health Access to Care Act would expand telehealth services for Medicare beneficiaries, including encouraging more virtual and telephonic mental health visits and eliminating requirements to go to periodic in-person visits to access telemental-health services.

  • While the discussion draft does not impact employer health plans, it lays the groundwork for larger action this summer on mental health.

After meeting with HR Policy, the Labor Department announced that it is “open” to issuing more mental health parity guidance on how employers can meet their complex reporting obligations. “There are conversations that we’re having on an ongoing basis with people who want more guidance,” Ali Khawar, Acting Assistant Secretary for the Employee Benefits Security Administration, said at an International Foundation of Employee Benefit Plans conference.

Outlook: While it’s unclear if the PBM bill has a path to enactment this year, there is a great deal of bipartisan interest in moving legislation to improve access to mental health services, including telemental health services. Meanwhile, DOL is expected to publish proposed parity guidance later this year.

Published on: May 27, 2022

Authors: D. Mark Wilson

Topics: Federal Health Care Reform, Wellness

D. Mark Wilson

President and CEO, American Health Policy Institute

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