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What Will Make It Into the PBM Legislation? | AMCP 2024


Ross Margulies, J.D., M.P.H., a partner at the Foley Hoag law firm, says there is broad agreement on transparency provisions and a ban on spread pricing in Medicaid.

After years of federal inaction, momentum started to build last year for legislation would impose new rules on the pharmacy benefit manager (PBM) industry. Many observers expect a bill to pass this year, during this Congress, although perhaps not until the lame-duck session after the Nov. 5 election. But what that bill will include is still far from certain, with various interest groups and ideas jostling for position and influence over what does and does not get included.

Ross Margulies, J.D., M.P.H., a partner in the Foley Hoag law firm, spoke about the PBM legislation today at the 2024 Annual Meeting of the Academy of Managed Care Pharmacy, which is being held in the Ernest N. Morial Convention Center in New Orleans.Margulies spoke to Managed Healthcare Executive in a recorded video call prior to the meeting. Foley Hoag, which is headquartered in Boston, has had many “drug supply chain actors” as clients and has represented the major PBMs, according to Margulies.

Margulies said in his interview with MHE that any PBM legislation that the senators and representatives agree upon is likely to include PBM pricing and fee transparency rules that will require the PBMs to share more detailed information with payers. Similar transparency requirements might be applied to Medicare Part D sponsors. He also said that after the transparency rules, the next most likely ingredient of a PBM bill would be a ban on spread pricing by PBMs serving Medicaid programs.

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