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On July 26, two different congressional committees considered reforms for the pharmacy benefit manager (PBM) industry. On the House side, the Ways & Means Committee considered a comprehensive, transparency-focused bill, which included transparency and disclosure requirements for PBMs. Additionally, the bill would prohibit cost-sharing in Part D from exceeding net prices. Although we would prefer to see cost-sharing based on net prices, at a bare minimum, cost-sharing should never exceed 100% of the PBM’s net price, so we were pleased to see the provision included.
Meanwhile, the Senate Finance Committee considered a comprehensive, dedicated PBM reform bill, which included a provision to delink drug prices from PBM compensation in Part D. In the days leading up to the markup, CSRO was able to provide Committee staff with support for that provision. During the working session, Committee leadership made clear that their work related to PBMs was not finished and that they viewed this as the first of at least two markups on the topic. The August congressional recess will be spent gathering and vetting additional PBM reform provisions.
To that end, CSRO asked the Committee to consider a provision requiring pass-through of price concessions to patients in the form of lower out-of-pocket costs. Such a provision is being seriously considered by the Committee for inclusion in the legislation during the next markup. In the end, the bill was voted out of Committee with overwhelming support. CSRO will continue to monitor and share updates as appropriate.
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