Pharmacy Benefit Managers: Regulation & What You Need to Know
- here's a breakdown of the three bills discussed in the text, summarizing their key features and differences:
- * Sponsor: Buddy Carter (D) in the House * Key Provisions: * delinks PBM compensation from drug costs in Medicare Part D.
- * Sponsors: Senators Mike Crapo (R) and Ron wyden (D) in the Senate * Key Provisions: * Delinks PBM compensation from drug costs in Medicare Part...
here’s a breakdown of the three bills discussed in the text, summarizing their key features and differences:
1. PBM Reform Act of 2025 (H.R.4317)
* Sponsor: Buddy Carter (D) in the House
* Key Provisions:
* delinks PBM compensation from drug costs in Medicare Part D.
* Prohibits spread pricing in Medicaid.
* Ensures accurate pharmacy payments in Medicaid.
* Unique to this bill: Increases oversight of pbms working with employer group health plans.
* assures pharmacy access and choice for Medicare beneficiaries.
* Relationship to Previous Bill: Includes most provisions from a previous House-passed budget reconciliation bill (May 2025) and adds provisions not in that earlier bill (oversight of employer plans,pharmacy access).
2. PBM Price Transparency and Accountability Act (S.3345)
* Sponsors: Senators Mike Crapo (R) and Ron wyden (D) in the Senate
* Key Provisions:
* Delinks PBM compensation from drug costs in Medicare Part D.
* Prohibits spread pricing in Medicaid.
* Ensures accurate pharmacy payments in Medicaid.
* Assures pharmacy access and choice for Medicare beneficiaries.
* Relationship to Previous Bill: Includes most provisions from a previous House-passed budget reconciliation bill (May 2025).
* Difference from PBM Reform Act: Does not include the provision for increased oversight of PBMs working with employer group health plans.
3. Pharmacists Fight Back Act (H.R. 6609 & H.R. 6610)
* Sponsors: Representatives Jake Auchincloss (D), Diana Harshbarger (R), and James Comer (R)
* Key Provisions:
* Requires PBMs in Medicare, medicaid, and Federal Employee Health Benefits Plans to reimburse pharmacies based on the National Average Drug Acquisition Cost (NADAC).
* Structure: Consists of two coordinated bills (H.R. 6609 & H.R. 6610) targeting different benefit programs.
In essence: All three bills aim to increase transparency and accountability of PBMs, notably regarding drug pricing and pharmacy reimbursement. The PBM Reform Act is the most thorough, specifically addressing employer-sponsored plans, while the other two focus on different aspects and programs.