PBMs Face More Pressure from Congress

By Consumers for Quality Care, on April 12, 2023

PBMs Face More Pressure from Congress

The latest pushback against Pharmacy Benefit Managers (PBMs) comes from Congressional lawmakers aiming to put a stop to the use of so-called “spread pricing” in the Medicaid program, Fierce Healthcare reports. 

Spread pricing is when a PBM charges a health insurance company more for a prescription drug than what they pay the pharmacy. To combat this practice, a bipartisan group of House lawmakers, led by Representative and pharmacist Buddy Carter (R-GA) and Representative Vincente Gonzalez (D-TX), have reintroduced the Drug Transparency in Medicaid Act.

Groups representing pharmacists have commended the bill’s reintroduction, with Douglas Hoey of the National Community Pharmacists Association denouncing spread pricing as a PBM money-making machine. “Through spread pricing in Medicaid alone, PBMs can hoard hundreds of millions of dollars each year,” Hoey said.

The legislation comes after lawmakers have called for more action against PBMs. Earlier this year, the Senate Commerce Committee held a hearing that discussed the lack of transparency from PBMs, Fierce Healthcare reported. 

CQC urges lawmakers and regulators to continue to take a close look at PBM practices that are driving up the cost of prescription medications for consumers.