Congress Primed to Crack Down on PBMs

By Consumers for Quality Care, on October 17, 2023

Many members of Congress, Capitol Hill staffers, and industry stakeholders believe that legislation aimed at reining in the pharmacy benefit manager (PBM) industry will pass before the legislative session ends, according to Modern Healthcare.

Several bipartisan bills have already emerged out of both House and Senate committees this year, an indication that these proposals have broad, bipartisan support in both legislative bodies.

In the Senate, Majority Leader Chuck Schumer (D-NY) is looking to pass a package of health care reforms. Although the details of the package remain unknown, it’s likely that the final legislation will include three PBM bills that have already passed out of various committees. On the House side, a larger bill consisting of smaller measures targeting PBMs awaits consideration, pending the vote for a new Speaker of the House.

The bill that eventually passes both chambers will likely require, among other things, more transparency from the PBM industry, which acts largely as a middleman, using deceptive practices to inflate costs and pad their own bottom line.

Congress and the Federal Trade Commission (FTC) have put on a united front in targeting PBM business practices. Congress has targeted PBMs to help consumers lower the cost of their medication, a concern many have raised in recent years. “There are few concerns that connect more with people at the kitchen table than healthcare,” said Senate Finance Chair Ron Wyden (D-OR). “Within that frame of how strongly people feel about healthcare is prescription drugs at the top of every list.”

CQC urges lawmakers and regulators to continue to scrutinize PBM practices that increase the cost of prescription medications for consumers.