Pharmacy Benefit Mgrs

Excerpted from a BipartisanPolicy.org post, Congress should:

• Require PBMs to provide cost disclosures and report on negotiations with drug manufacturers and profits from spread pricing and pharmacy fees to plan sponsors
• Report annually to the FTC on spread pricing, pharmacy payments, changes to formulary tiers, and differences in reimbursements to different pharmacies  [so] policymakers and employers could better determine whether and by how much PBMs are impacting the cost of drugs and thus design evidence-based solutions
• [With] transparency requirements ... employers could negotiate fairer contracts with PBMs to mandate transparency, limit spread pricing, and require pass-throughs.

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BILLS

Nov. 8, 2023 [to improve services provided by PBMs] (H.R.6283) –Rep. Miller-Meeks, et al., referred to 4 committees

Co-sponsors: (Dem) Barragán, Manning, Schneider, Spanberger, Auchincloss, Thanedar, Davis, Cherifilus-McCormick, Sherrill; (Rep) Chavez-DeRemer, Malliotakis, Kean, Harshbarger, Valadao, Kiggans, Dunn, Van Drew, Hudson, Letlow, Bean, Brandon, Lawler, Grothman, Flood
Summary [unavailable as of Aug. 2, 2024]
https://www.congress.gov/bill/118th-congress/house-bill/6283

July 7, 2023 Pharmacists Fight Back Act (H.R.9096) – Rep. Auchincloss, referred to 4 committees

Co-sponsors: (25 Dem) 25, (26 Rep, incl. 1 original)
Summary (unavailable as of Dec. 4, 2024) but subtitle: To establish pharmacy payment and reimbursement by PBMs; to amend title XIX of the Social Security Act to improve prescription drug transparency; and for other purposes
 https://www.congress.gov/bill/118th-congress/house-bill/9096/text

May 22, 2023 Patient Act of 2023 (H.R.3561) – Rep. McMorris Rodgers and Pallone, referred to 3 committees

Co-sponsors: (41 Dem) including Lee, Schiff, Jackson Lee, Tlaib, Dingell, Gallego, Lieu; (46 Rep)
Summary: This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and PBMs. The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps.     Specifically, the bill provides statutory authority for the requirement that hospitals publish an annual list of shoppable services they provide, including specified pricing information. Beginning in 2025, a hospital may not use an internet-based price estimator tool to meet the publication requirement for shoppable services.       The bill also modifies the health insurance plan disclosure requirements to include the rates for certain in-network services and prescription drug payment information.     The bill further requires providers of diagnostic laboratory tests under Medicare to publish online certain price information. Medicare Advantage (MA) organizations must report information about payments made to providers in which the MA organization has an ownership interest. Medicare prescription drug plan sponsors must report certain price information for covered drugs.        Additionally, the bill requires health insurance plan issuers (or the PBM providing services on behalf of the plan) to report to the plan sponsor specified information about prescription drugs dispensed under the plan. This includes rebates, fees, alternative discounts, or other remuneration the plan receives from drug manufacturers.      Finally, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid.
https://www.congress.gov/bill/118th-congress/house-bill/3561

April 26, 2023 “Protecting Patients Against PBM Abuses Act” (H.R.2880) to amend Title XVIII of the SSA to establish certain requirements for PBMs under part D – Rep. Carter, et al., referred to 2 committees

Co-sponsors: (Dem) Blunt, Auchincloss, Ross, Cleaver, Sherrill, Barragán, Cherfilus-McCormick, Davis, Cartwright, Jackson, Vasquez, Spanberger, Salina, Caraveo, Levin; (Rep) Malliotakis, Van Drew, Miller-Meeks, Dunn, Carl, Mann, Ferguson, Harshbarger, Allen, Miller, Valadao, Scott, Hudson, Fleischmann, McCormick, Lawler, Grothman, Rose, Flood, LaLota
Summary: This bill establishes requirements for Medicare PBMs with respect to remuneration, payments, and fees.     Specifically, the bill restricts PBMs that are under contract with plans under the Medicare prescription drug benefit or Medicare Advantage from (1) receiving income for their services other than flat dollar amount service fees; (2) basing any service fees on the prices of covered drugs or any associated discounts, rebates, or other remuneration; (3) charging plan sponsors for ingredient costs or dispensing fees in amounts that are different than what is reimbursed to the pharmacy; or (4) reimbursing network pharmacies for less than that what is reimbursed to PBM-affiliated pharmacies.      Such PBMs must also report on the difference between certain costs for drugs on the plan's formulary and those that are not on the formulary but are therapeutically equivalent. PBMs must also report certain information regarding rebates and fees they receive from drug manufacturers; the Centers for Medicare & Medicaid Services must publish this and other information that is currently reported by PBMs online.
https://www.congress.gov/bill/118th-congress/house-bill/2880

April 26, 2023 “Protect 340B Act of 2023” (H.R.2534) – Rep. Spanberger and Johnson, referred to 2 committees

Co-sponsors:(29 Dem), (5 Rep) 
Summary: This bill prohibits PBMs and health insurance plans from discriminating against health providers participating in the 340B drug pricing program, including pharmacies contracted with such providers to dispense 340B drugs. The 340B program allows certain providers to receive covered outpatient drugs at reduced prices from manufacturers [contd....]
https://www.congress.gov/bill/118th-congress/house-bill/2534

 

Jan. 26, 2023 “Pharmacy Benefit Manager Transparency Act of 2023” (S.127) – Sens. Cantwell, et al., referred to Commerce, Science and Transportation; reintroduction of 2022 bill below

Co-sponsors: (Dem) Tester, Welch, Heinrich, Shaheen; (Rep) Hyde-Smith, Braun, Moran, Tillis, Capito, Boozman, Marshall, Ernst, Rounds
Summary: same as earlier S.4293 below
https://www.congress.gov/bill/118th-congress/senate-bill/127

Jan. 26, 2023 “Prescription Pricing for the People Act of 2023” (S.113) – Sens. Grassley, et al., referred to Judiciary, then placed on legislative calendar

Co-sponsors: (Dem) Cantwell, Blumenthal, Welch, Coons, Hirono, Feinstein, Casey, Rosen, Shaheen, Warnock;  (Rep) Lankford, Blackburn, Tuberville, Tillis, Capito, Braun, Boozman, Marshall, Budd, Collins;  (Ind) Sinema
Summary: This bill requires the Federal Trade Commission (FTC) to report about anticompetitive practices and other trends within the pharmaceutical supply chain that may impact the cost of prescription drugs. The FTC also must provide recommendations to increase transparency in the supply chain and prevent anticompetitive practices.
https://www.congress.gov/bill/118th-congress/senate-bill/113

May 24, 2022 “Pharmacy Benefit Manager Transparency Act of 2022” (S.4293) – Sens. Cantwell and Grassley, referred to Commerce, Science and Transportation

Co-sponsors: (Dem) Tester; (Rep) Boozman, Braun, Moran, Tillis, Hyde-Smith, Capito
Summary: This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.
The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.     PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.     Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.     The FTC and state attorneys general are authorized to enforce the provisions of the bill.
https://www.congress.gov/bill/117th-congress/senate-bill/4293

Additional House bills 2023-24 to regulate PBMs: H.R.2816, 2679, 9096, 7717, 5385, etc.  
Additional Senate bills 2023-24 to regulate PBMs: S.1339, 3330, 1967, 1542 etc.