PBMs targeted in health deal
Dec 17, 2024
Presented by PBM Accountability Project — The Hill obtained the text ahead of the release of the full bill{beacon}
Health Care
Health Care
The Big Story PBMs targeted in health dealLawmakers agreed to attach a sweeping health care package to a year-end stopgap government funding legislation, according to text obtained by The Hill ahead of the release of the full bill.
© APThe provisions in the bill, if passed, could represent some of the biggest health policies in Congress this year. The health portion runs more than 550 pages and contains:Pharmaceutical benefit manager (PBM) industry reforms
Extensions of Medicare telehealth flexibilitiesReauthorizations of legislation to prevent pandemics and address the opioid crisisPayments to community health centers
A rollback of physician payment cuts and other policies. The PBM changes would put guardrails on the business practices of the industry, something that’s been a bipartisan priority for years but, until now, never made it to the finish. The package includes a ban on linking PBM compensation to a drug’s Medicare list price. The bill also requires PBMs to “fully pass through 100 percent of drug rebates and discounts … to the employer or health plan.”
The package includes new reporting requirements to increase transparency It would ban “spread pricing,” changing how PBMs get paid by Medicaid for prescription drugs.
The three biggest PBMs are UnitedHealth Group’s Optum Rx, CVS Health’s Caremark and Cigna’s Express Scripts.
PBMs wield enormous power on the accessibility and affordability of prescription drugs, and those three companies represent about 80 percent of all U.S. prescriptions.
PBMs also negotiate the terms and conditions for access to prescription drugs for hundreds of millions of Americans. They are responsible for negotiating prices with drug companies, paying pharmacies and determining which drugs patients can access and how much they cost.
The industry has faced intense scrutiny on Capitol Hill this year, and essentially every committee with jurisdiction over health care has drafted PBM reform legislation.
Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel, Joseph Choi and Alejandra O'Connell-Domenech — every week we follow the latest moves on how Washington impacts your health.
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