Almost done = Pharmacy Benefit Manager legislation before Congress – what’s it all about? I wonder why it is going through before the Trump Administration takes over?
From here:
PBM reform, telehealth extension, doctor pay in federal spending deal | STAT
“WASHINGTON — After two years of haggling, Congress has nearly reached a deal to rein in the drug-industry middlemen known as pharmacy benefit managers.”
“Lawmakers agreed to extend telehealth flexibilities, fund public health programs, and enact these major PBM changes as part of a government funding package they are planning to pass before the end of the year, according to four health care industry sources and two congressional aides. The language of the government funding package has not been publicly released and could still change.”
“The pharma industry spent millions on advertising to promote PBM legislation, and it appears it will get most of what it wanted. “
Mus be all good then, right?
Here’s an extract from Brave AI:
1 “Pharmacy Benefit Managers Bill
Based on the provided search results, here’s a summary of what’s in the draft bills and proposed legislation aimed at regulating pharmacy benefit managers (PBMs):
1. Pharmacy Benefit Manager Transparency Act of 2023 (S.127):
o Prohibits PBMs from engaging in certain unfair or deceptive practices, such as:
§ Charging health plans a different amount than what they reimburse pharmacies.
§ Arbitrarily clawing back reimbursement payments or increasing fees to offset changes to federally funded health plans.
o Requires PBMs to disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.
o Mandates annual reporting to the Federal Trade Commission (FTC) of certain information about payments received from health plans and fees charged to pharmacies.
2. Pharmacy Benefit Manager Transparency Act of 2022 (S.4293):
o Prohibits unfair or deceptive prescription drug pricing practices by PBMs.
o Authorizes the FTC to investigate and enforce these provisions.
o Provides for reinstatement of employment, back pay, and damages for individuals harmed by PBM violations.
3. Pharmacists Fight Back Act (introduced in 2024):
o Requires PBMs to share 80% of rebates with patients.
o Prohibits certain practices, including:
§ Steering patients to PBM-affiliated pharmacies.
§ Excluding in-network pharmacies from filling prescriptions.
§ Charging patients for branded medications when cheaper generic alternatives are available.
4. Patients Before Monopolies (PBM) Act (introduced in 2024):
o Prohibits joint ownership of PBMs and pharmacies, addressing conflicts of interest.
o Requires violators to divest their pharmacy businesses within three years.
o Authorizes the FTC, Department of Health and Human Services, Antitrust Division of the Department of Justice, and state attorneys general to issue orders requiring divestiture and disgorgement of revenue.
o Directs the FTC to distribute disgorged revenue to harmed communities, including consumers overcharged at vertically integrated pharmacies.
5. Proposed State Legislation (various bills introduced in 2023):
o Eliminate spread pricing, a practice where PBMs earn profits by keeping the difference between the price they pay for drugs and the higher price they charge to health plans.
o Expand reporting obligations, requiring PBMs to disclose drug pricing information, including total out-of-pocket spending, net spending, and remuneration received from drug manufacturers.
o Reshape the relationship between PBMs and their affiliated pharmacies.
o Constrict PBMs’ outlets for remuneration.
These draft bills and proposed legislation aim to increase transparency, fairness, and competition in the PBM industry, ultimately benefiting patients and independent pharmacies.”
Clear as mud to me, but I am sure it is crystal clear to those in the industry!
Onwards!!!
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