Rep. L. “Buddy” Carter (R-Georgia) introduced the PBM Reform Act last week, which aims to combat pharmacy welfare managers (PBM) practices.
The bill was bipartisanly supported and was represented by representatives Debbie Dingell (D-Michigan), Greg Murphy (R-North Carolina), Deborah Ross (D-North Carolina), Jodey Arrington (R-Texas), Diana Harshbarger (r-Tennessee), Vicente Gonzalez (Rick) (D-Niana) (R-Georgia), Raja Krishnamoorthi (D-illinois), John Rose (R-Tennessee), Derek Tran (D-California) and Nicole Malliotakis (R-New York).
The bill would prohibit the spread of pricing in Medicaid. This is what PBM pays to payers more than they pay for medications and then holds the difference as profit. It also attempts to “disconnect” from the cost of drug in Medicare Part D PBM compensation.
Additionally, it will require semi-annual reports to understand drug spending, rebates and development determination. It will also require that the “reasonable and relevant” contractual terms and resolution of violations be enforced in the Medicare D Part Pharmacy contract.
The introduction of the bill is controlled by three major PBMs (CVS Caremark, Optum RX from UnitedHealth Group and Cigna's Express scripts) that control 80% of the prescription drug market.
“It’s time to destroy the PBM monopoly, stealing hope and health from patients for decades. As a pharmacist, I’ve seen how PBMS abuses patients in person and believe that the treatment for this infectious disease is the transparency, competition and responsibility of our bipartisan package, which is exactly what our husband and wife program has to offer.”
Dingell, Michigan, responded to Carter's comments.
“For a long time, pharmacy welfare managers have been allowed to operate unrestricted, raise prices and prevent many patients from getting the medication they depend on,” Dingell said in a statement. “Because the exploitative PBM habits that allow you to use your local pharmacy makes them useless, I hear too much of Michigan, especially older people, who have no easy access to the prescriptions they need. Their harmful, aggressive strategies will only get worse, we have to act, and now we have to act to protect the pharmacy and reduce the cost of the patients. I still commit to getting along with my colleagues, an effort to make both the scope of both, which is top-notch for the family.”
Many other efforts to target PBM. Arkansas recently enacted a law that prohibits PBMs from owning and operating pharmacies in the state, prompting CVS Caremark and Express Scripts to file separate lawsuits to challenge the law. Last December, Senators Elizabeth Warren and Josh Hawley introduced a bipartisan bill that would also ban PBMs that own pharmacies.
Photo: z_wei, Getty Images
