Senate Committee Advances PBM Transparency Legislation

The Senate Commerce Committee passed legislation, Pharmacy Benefit Manager Transparency Act of 2022 (S. 4293) , that is designed to address how PBMs control drug prices and can potentially reduce the amount independent pharmacies and consumers pay for medicine.

PBMs manage prescription drug benefits for insurance plans and payers. They receive rebates and discounts on drug prices and are supposed to pass savings on to patients—but they often don’t, and in fact limit access through formulary exclusions. The proposed legislation would make it illegal for PBMs to engage in “spread pricing”, whereby PBMs charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy, and then pocket the difference.

The Senate Commerce Committee approved the legislation 19-9 and added two amendments—one requiring a Government Accountability Office report to examine PBM practices and potentially recommend further legislation, and another specifying which officials can bring civil suits against PBMs.

MichBio, along with other state and national partners, supports the bill. As a side note, Federal Trade Commission (FTC) recently solicited comments on PBM business practices too, so there’s tremendous federal focus on middlemen influence on drug pricing.