PBM Legislative Update: Which Provisions Stand the Best Chance of Making It Into a Final Bill and Become Law? | AMCP Nexus 2023


Melissa Andel, M.P.P., sees delinking of administrative fees to drug prices and various transparency and disclosure provisions as likely to make it into a final pharmacy benefit manager (PBM) legislation making it into a final bill.

It is safe to say that pharmacy benefit managers (PBMs) are not among the priorities in Washington right now with the Israel-Hamas conflict raging and the House without a speaker.

But in an interview conducted before of Academy of Managed Care Pharmacy (AMCP) Nexus meeting, Melissa Andel, M.P.P., said she believe sthere is a chance of PBM legislation passing this year and that it will include provisions with wide support, such as the delinking of PBM administrative fees from the list price of drugs and new transparency and disclosure requirement.

Currently there is one consolidated PBM bill in the House but three seperate ones in the Senate.

Andel, whose healthcare consulting business is called CommonHealth Solutions, spoke yesterday at the AMCP Nexus 2023 meeting in Orlando.

Andel said it was open question whether any rules uncoupling administrative fees from prices will be applied to commercial plans and Medicare Part D plans or just Medicare Part D.

The proposals about transparency and disclosure vary. Andel said disclosure transparency into t pricing strategy and negotiations may have some unintended consequences. “I know if you speak to economists, they argue that when you go into negotiation, the promise of confidentiality is always going to result in a different agreement than what would have otherwise been reached if all the parties know at some point the negotiation will be made public.”

Andel said “there are theories out there that say the negotiations will not be as aggressive as they are today.”

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