The Senate HELP Committee’s Pharmacy Benefit Manager Reform Act (PBMRA) is arguably the most sweeping bipartisan PBM reform bill that has been introduced in Congress.
- The amounts paid directly or indirectly in rebates, fees, or any other type of compensation to brokers, consultants, and advisors who referred the employer plan to the PBM; and
- The amount received, or expected to be received, by a PBM in rebates, fees, alternative discounts, or other remuneration paid by other entities in the pharmacy supply chain.
Rebate pass-throughs, spread pricing and independent audits. The bill would require PBMs to remit 100% of rebates fees, alternative discounts, and other remuneration to employer plans; prohibit spread pricing beginning January 1, 2025; and enable employers to choose the auditor for their PBM audit.
PBMs announce new initiatives to lower drug costs. Optum Rx is offering new payment choices and transparency solutions as is Express Scripts, likely a response to the increased political pressure on PBMs.
Two separate House hearings on health care costs (here and here) also focused on increasing transparency, expanding telehealth, improving stop-loss insurance for large employers, site-neutral payments, and hospital facility fees. HR Policy and other employer groups provided a joint statement supporting some of the legislation that was discussed and urged Congress to take additional steps.
Outlook: The Senate HELP Committee announced it will vote on the Pharmacy Benefit Manager Reform Act on May 2, 2023, and the bill could be included in a larger drug pricing package that Senate Majority Leader Chuck Schumer wants to move later this year.