Senate leaders introduce bipartisan PBM reform bill

WASHINGTON – U.S. Senate Finance Committee Chairman Mike Crapo, R-Idaho, and Ranking Member Ron Wyden, D-Ore., today introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act to fix market distortions and increase transparency in federal prescription drug programs to lower patient costs at the pharmacy counter. 

“Pharmacy benefit managers should not profit from overcharging patients for their prescriptions,” said Crapo. “This bipartisan legislation is a decisive step toward making the prescription drug market easier to navigate for both patients and pharmacies. These proposals form a strong foundation for additional efforts to promote pharmacy access, demystify drug pricing and reduce costs for both taxpayers and seniors.” 

The PBM Price Transparency and Accountability Act would: 

• Delink PBM compensation from their negotiated rebates to disincentivize PBMs from promoting higher-priced medications; 

• Increase PBM reporting requirements to Medicare Part D plan sponsors and to the U.S. Department of Health and Human Services (HHS) and empower Part D plan sponsors to audit their PBM for compliance with contract requirements; 

• Reinforce existing requirements that plan sponsors contract with any willing pharmacy that meets their standard contract terms and conditions to better protect independent pharmacies in rural areas from practices that have contributed to widespread closures; 

• Require participation by retail community pharmacies in the National Average Drug Acquisition Cost (NADAC) survey, which would ensure accurate Medicaid payments to pharmacies; and 

• Mandate PBMs pass Medicaid payments directly to pharmacies to ensure transparent drug costs for states and taxpayers. 

The National Community Pharmacists Association (NCPA) is urging Congress to pass the bill. 

“We would like to thank Chairman Crapo and Ranking Member Wyden for their hard work and steady support for these reforms,” said NCPA CEO B. Douglas Hoey. “The president and Congress have expressed a strong interest in bringing down drug costs and these reforms are the most comprehensive and substantive way to make progress toward achieving that goal. NCPA urges Congress and the president to pass this legislation and sign it into law. The PBMs and insurance conglomerates are driving up drug costs, crushing small-business pharmacies, and creating pharmacy deserts. There is wide bipartisan support for these reforms, so there are no excuses for letting another year slip by without passing them.”  

The bill contains the same key reforms that nearly passed last December but were stripped out at the last minute when spending negotiations broke down, says NCPA. 

The following senators co-sponsored the bill: 

• John Barrasso, R-Wyo. 

• Michael Bennet, D-Colo. 

• Marsha Blackburn, R-Tenn. 

• Catherine Cortez Masto, D-Nev. 

• Bill Cassidy, R-La. 

• Maggie Hassan, D-N.H. 

• John Cornyn, R-Texas 

• Ben Ray Luján, D-N.M. 

• Steve Daines, R-Mont. 

• Tina Smith,D-Minn. 

• Chuck Grassley, R-Iowa 

• Mark Warner, D-Va. 

• James Lankford, R-Okla. 

• Raphael Warnock, D-Ga. 

• Roger Marshall, R-Kan. 

• Peter Welch, D-Vt. 

• John Thune, R-S.D. 

• Sheldon Whitehouse, D-R.I. 

• Thom Tillis, R-N.C. 

The legislative text can be found here.