PBM Legislative Update: Common Themes in the Legislation | AMCP Nexus 2023

All legislative and political jockeying around tightening regulation of pharmacy benefit managers (PBMs) has reified into four bills, one in the House and three in the Senate that have emerged from three different committees. Today at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando, Melissa Andel, M.P.P., outlined the PBM legislation and shared insights into which provisions stand the best chance of surviving and becoming law.

In a Zoom interview with Managed Healthcare Executive prior to the meeting, Andel described some of the themes of the legislation.

The Senate bills differ, partly because the three committees that have considered PBM legislation have different jurisdictions. Andel said some of the common threads running through the legislation that Congress has debated include rebate pass throughs (to the health plan, not to individual patients), a variety of new transparency and disclosure requirements and, in some bills, a ban on spread pricing.

Delinking PBM administrative fees from the price of drugs has a lot of support, Andel noted: “Congress is really trying to move away from incentives that encourage manufacturers to continue to increase list prices so they can increase rebates.”

Andel observed that the provisions of the current crop of bills would, if they become law, mean milder change for the PBM industry than some earlier versions. The emphasis has shifted, she said, to disclosure and transparency about rebates, acquisition costs and other details rather than outright bans on some of the PBM business practices that have been criticized by some lawmakers and industry critics,

“What we have seen overall is a roll back in some of the more severe or harsh PBM regulation,” Andel said.