The role of pharmacy benefit managers in the health care space is being scrutinized more than ever before.
Not many issues in the United States government can be described as truly bipartisan, but both Democrats and Republicans have used their voting power recently to try and reign in the power of pharmacy benefit managers (PBMs). Recently, the House Energy and Commerce Committee attempted to take steps towards drug price transparency by advancing multiple health care bills and measures aimed at creating more transparency in health care, according to an Axios report.1
HR 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT)is an act intended to lower some prescription drug prices and bring transparency to PBMs attempting to make the market non-competitive.
Starting January 1, 2024, HR 3561 will require hospitals to provide “a plain language description of each item or service” it provides to a patient, as well as “the gross charge, expressed as a dollar amount, for each such item or service, when provided in, as applicable, the hospital inpatient setting and outpatient department setting.”2
The response to this vote was positive acrossthe pharmacy community. “Patients and community pharmacies have been advocating aggressively for years for reforms and insight into PBM practices,” said Anne Cassity, senior vice president of government affairs at the National Community Pharmacists Association(NCPA) in a statement.3 “This comprehensive package would take significant strides forward in terms of federal oversight, and NCPA is proud to support it. We’re grateful to the committee for its work and hope the full House will soon advance it.”
The bill, which was sponsored by Cathy McMorris Rodgers(R-Washington) and Frank Pallone Jr (D-NewJersey) passed in a unanimous 49 to 0 vote. "We spend more on health care as a percentage of our economy than any other developed nation,” said McMorris Rodgers. “This is just a first step towards addressing the problems we face.”
HR 3561 was not the only health care bill to pass in the House Committee recently, asHR 2666, the Medicaid VBPs for Patients (MVP)bill passed by a vote of 31-19.4 HR 3284, the Providers and Payers COMPETE Act also passed unanimously. That bill aims to “require the Secretary of Health and Human Services to submit an annual report on the impact of certain Medicare regulations on provider and payer consolidation.”
Legislation around PBMs has become more prevalent. Earlier this year, Maria Cantwell (D-Washington) introduced the Pharmacy Benefit Manager Transparency Act of 2023.
With PBMs able to dictate how much individuals must pay out-of-pocket for medications, these bills and measures are necessary steps towards a more equitable health care system. “We can be proud of the meaningful, bipartisan policies included in this amendment that will lower costs and improve transparency for patients,” McMorris Rodgers said.