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PBM Legislative Update: One Bill in the House, Three in the Senate | AMCP Nexus 2023


Melissa Andel, M.P.P., of CommonHealth Solutions LLC, thumbnailed the four pieces of legislation advancing through Congress that would tighten regulation and oversight of pharmacy benefit managers (PBMs).

In Washington and in healthcare, pharmacy benefit managers (PBMs) are in the legislative hotseat.

Today at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando, Melissa Andel, M.P.P.,summarized the various PBM bills under consideration and shared some insights into the legislative anbd political forces that are shaping their future and which provisions, if any, will survive and become law.

In a Zoom interview with Managed Healthcare Executive before the meeting, Andel, whose healthcare consultancy is called CommonHealth Solutions and who has worked in legislative affairs for AMCP, gave a brief overview of the PBM bills that have advanced in this session of Congress. A single bill has been put together in the House, according to Andel.

“On the Senate side, it’s a little bit more complicated,” said Andel, with separate bills having been voted out of the finance, health, education, labor and pensions, and commerce committees. The content of those bills is determined, in part, by the jurisdictions of those committees, Andel explained. For example, the Senate Finance Committee’s has jurisdiction over Medicare and Medicaid so its PBM legislation focuses on changing Medicare and Medicaid rules for PBMs and how drug expenditures are managed and covered.

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