PBM Drug Pricing Transparency Bill Heads to Senate
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The Senate Committee on Commerce, Science and Transportation recently advanced a bill to increase pharmacy benefit manager (PBM) transparency and combat what some legislators called “deceptive practices.” The proposed bill received bipartisan support in the committee, with an 18-to-9 vote, and is supported by many health care and consumer organizations.
The Pharmacy Benefit Manager Transparency Act identifies activities that would be unlawful for PBMs to engage in, including the following:
- Spread pricing, a practice in which PBMs charge health plans and payers more for prescription drugs than they reimburse pharmacies
- Clawing back reimbursement payments from pharmacies
Additionally, PBMs would be required to direct 100% of any rebate to the plan or payer and disclose the cost and reimbursement to the health plan.
PBMs were initially formed to process claims and negotiate lower drug prices with drug makers. Today, they administer prescription drug plans for hundreds of millions of Americans and manage many aspects of the prescription drug process for health insurance companies, self-insured employers, unions and government programs. This includes developing lists of covered medications, negotiating rebates from drug manufacturers and contracting with pharmacies for reimbursement. According to the Pharmaceutical Care Management Association, PBMs play a positive role in creating savings and options and providing expertise for employers regarding prescription drug benefit design and coverage.
What’s Next?
Since PBMs have largely operated out of the view of regulators and consumers, this bill could impact how PBMs operate, potentially increasing prescription drug transparency. There’s currently no timeline for the Senate to consider the bill. Last year, the Senate Committee on Commerce, Science and Transportation passed the same bill, but it was never put to a full vote on the Senate floor.
Employers should continue to monitor the situation closely. [B_Official] will keep you apprised of notable changes.
- Published in Blog
NEWS BREIF: Senate Passes the Inflation Reduction Act
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
The U.S. Senate recently passed the Inflation Reduction Act, which includes provisions aimed at addressing climate change, reducing the high costs of prescription drugs and lowering the deficit by approximately $300 billion. The $750 billion spending bill passed through the budget reconciliation process, meaning all 50 Democrats and one tie-breaker vote from Vice President Kamala Harris were all that was needed.
How Will the Inflation Reduction Act Impact Health Care Policy?
The legislation includes provisions to lower prescription drug prices by allowing the federal health secretary to negotiate the prices of certain expensive drugs annually for Medicare. However, this will not impact every prescription drug and will not happen quickly. The negotiations will begin in 2026 for a maximum of 10 prescription drugs covered by Medicare, another 15 drugs in 2027 and 2028, and then 20 drugs in 2029. Additionally, pharmaceutical companies will be required to issue rebates if they raise drug prices beyond the rate of inflation.
The bill originally included a provision capping insulin at $35 per month for privately insured and Medicare patients. However, the Senate parliamentarian ruled the provision for privately insured patients out of order and removed it before the legislation was passed. The bill does cap out-of-pocket prescription drug costs at $2,000 for people on Medicare beginning in 2025.
Importantly, the bill helps millions of Americans avoid sharp increases in health care costs by extending enhanced Affordable Care Act subsidies for three years, one year later than originally proposed by the U.S. Congress.
What Else Does the Inflation Reduction Act Address?
The bill represents the largest climate change investment in U.S. history, with the goal of reducing U.S. carbon emissions by 40% by 2030. The bill contains tax incentives to reduce the cost of electricity by investing in renewable energy infrastructure and incentivizing Americans to switch to electric power for their homes and vehicles.
To boost revenue, the bill imposes a 15% minimum tax on the income of large corporations that earn at least $1 billion per year. This is expected to raise $300 billion in government revenue. The bill also levies a 1% excise tax on stock buybacks that will take effect in 2023. Some experts believe this will result in a rush on buybacks by some companies before the excise tax takes effect next year.
What This Means
The U.S. House plans to take up the bill at the end of the week. If the House passes the bill, which experts anticipate will happen, the legislation will be sent to President Joe Biden for signature. As this legislation is anticipated to impact large segments of the U.S. economy, employers will want to follow the process closely.
We will keep you apprised of any notable updates. Contact RISQ Consulting for more health care resources.
- Published in Blog