Recent efforts to reform pharmacy benefit managers (PBMs) in the United States were thwarted as Congress failed to include measures in the bipartisan government funding package. These measures aimed to increase transparency in the industry and change certain practices of PBMs, which act as intermediaries between drug manufacturers and insurers.
The proposed legislation would have required PBMs to disclose more information on negotiated rebates, drug pricing, and pharmacy compensation. It also sought to eliminate the connection between drug prices and PBM compensation in Medicare Part D plans, shifting to a flat fee payment model.
Additionally, the bill would have mandated PBMs to pass on all rebates to health plan sponsors, potentially eliminating spread pricing in Medicaid. The goal was to enhance transparency and alter the industry's compensation structure to prevent incentives for favoring higher-cost drugs.
While the PBM trade group argued that the legislation would not reduce costs and could lead to higher premiums for seniors, opponents of the industry expressed disappointment over the removal of these provisions.
Meanwhile, the Federal Trade Commission (FTC) took legal action against major PBMs, including CVS Health's Caremark Rx, Cigna's Express Scripts, and UnitedHealth Group's Optum Rx, alleging price inflation of insulin. The FTC's lawsuit highlighted concerns over rising insulin costs and the role of PBMs in exacerbating the issue.
The industry's trade group defended PBMs, stating that they are working to lower insulin costs through increased competition. However, the FTC's move reflects ongoing efforts to address pricing practices within the pharmaceutical industry.
Despite the setback in Congress, the push for PBM reform is expected to continue, with stakeholders advocating for changes to benefit patients, reduce costs, and promote fair competition in the healthcare sector.
