NACDS continues to urge the U.S. Congress to finish the job – and enact the bipartisan PBM reforms that Congress has advanced in the 118th Congress. A January 19 Inside Health Policy article quotes NACDS on the topic:
“The U.S. Congress has already done much of the hard work – on a bipartisan basis – to help deliver the pharmacy benefit manager (PBM) reforms in Medicaid and Medicare that are essential for patients, communities, and the pharmacies of all types on which they rely. The PBMs are trying to run out the clock on real reform. Congress must not fall for that,” Kathleen Bashur, senior manager of Media Relations for the National Association of Chain Drug Stores (NACDS), told IDP.
Read the Inside Health Policy article in its entirety below:
CR Extension Offers Extra Time For PBM Reform Passage
By Gabrielle Wanneh / January 19, 2024 at 5:51 PM
The status of several pharmacy benefit manager reforms remains up in the air after Congress passed a new stopgap spending bill Thursday (Jan. 18) that temporarily extends federal government funding through March 1 and March 8, giving lawmakers and PBM reform advocates another seven weeks to hash out their differing PBM reform bills for possible movement alongside a March spending bill.
Given the amount of time lawmakers spent to introduce and pass legislation to boost PBM transparency and accountability throughout 2023, Horizon Government Affairs CEO Joel White says lawmakers likely want to push their reforms over the finish line. White predicted a deal involving PBM reforms will likely come together in March once all fiscal 2024 funding priorities are agreed to.
At issue is how lawmakers will cobble together and choose from a series of PBM reforms passed out of the House and key Senate committees in 2023:
- The Lower Costs, More Transparency Act, a broad health care transparency bill passed by the House in December includes PBM reporting requirements, a ban of spread pricing for PBMs that contract with Medicaid managed care organizations and requirements for PBMs to disclose information on their compensation with plan fiduciaries.
- The Pharmacy Benefit Manager (PBM) Reform Act, legislation passed out of the Senate health committee in May, in addition to its own reporting requirements and spread pricing ban, calls for PBMs to pass through 100% of rebates, fees and other discounts to health plans, directs the Labor Department to conduct a study of PBMs’ fiduciary responsibilities and requires PBMs disclose information on prescription drug spending by a health plan and its beneficiaries.
- The Modernizing and Ensuring PBM Accountability (MEPA) Act, passed by the Senate Finance Committee in July, would delink PBM compensation from prescription drug list prices, direct the HHS Office of Inspector General to review the state of PBM compensation and study Part D drug mark-ups, and ban spread pricing in Medicaid. CBO has estimated delinking PBM fees from drug list prices to net more than $200 million in savings under Part D, while commercial market delinking is estimated to reduce the deficit by more than $650 million.
The House Energy & Commerce Committee also passed several more PBM policies in December, including a policy to limit PBM income to nothing outside of flat dollar amount service fees for the pharmacy benefit services provided for Medicare Part D drugs — a reform similar to that included in Senate Finance’s MEPA Act.
Multiple advocacy groups and lobbies interested in changing the way PBMs operate are pushing for these reforms to be part of any final health spending deal. Melissa Bartlett, senior vice president of health policy for the ERISA Industry Committee (ERIC), says she’s highly optimistic due to the vast bipartisan support for so many PBM policies despite major opposition from the PBM lobby over such measures.
“I think the discussion points around the need for reform and the need for transparency, as well as the individual policies themselves, have been fully litigated by all sides. There really is nothing more you could say or do to show that PBM reform and transparency is necessary,” Bartlett told Inside Drug Pricing.
Bartlett also says there’s pressure for Congress to pass PBM reform because of the 2024 election and the need for lawmakers to highlight important accomplishments as they run for reelection, including the passage of legislation that would make drugs more affordable. Even if it wasn’t an election year, Bartlett says it would be odd for lawmakers to ignore passing PBM reform considering the level of attention given to the issue.
ERIC and other employer groups continue to advocate especially for the passage of the PBM reforms included in the Senate Finance and health committee bills, as they believe that although PBM transparency is crucial, reporting requirements will not be enough to secure structural changes needed to ensure PBMs’ operations are beneficial to the clients they contract with and beneficial to patients.
Throughout 2023, pharmacy groups also praised lawmakers for their growing interest in tackling PBM tactics such as spread pricing and patient steering; understanding how these tactics affect the ability of independent pharmacies to remain in business and serve their communities; and considering provisions to improve interactions between PBMs, pharmacies and other supply chain stakeholders.
“The U.S. Congress has already done much of the hard work – on a bipartisan basis – to help deliver the pharmacy benefit manager (PBM) reforms in Medicaid and Medicare that are essential for patients, communities, and the pharmacies of all types on which they rely. The PBMs are trying to run out the clock on real reform. Congress must not fall for that,” Kathleen Bashur, senior manager of Media Relations for the National Association of Chain Drug Stores (NACDS), told IDP.
Did You Catch This?
NACDS has released a television ad – titled “Get It Done” – urging the U.S. Congress to not allow PBM reform to fall by the wayside amid unrelated political dynamics, and to not allow PBMs to succeed in running out the clock on real reform.
