The new GOP spending bill proposal does not include sweeping changes to how pharmacy benefit managers (PBMs) operate, according to sources familiar with the matter. This decision comes as a surprise to many, as the initial bipartisan deal was expected to address the controversial practices of PBMs.
The bipartisan deal, which was part of the proposed legislation, aimed to introduce a series of reforms for PBMs. These middlemen, who stand between drug manufacturers and insurers, have faced criticism for their lack of transparency in pricing and rebate negotiations.
One of the key provisions of the deal was to require PBMs to disclose more information about the rebates they negotiate and retain, as well as details on drug pricing and pharmacy compensation. Additionally, the agreement sought to disconnect the price of drugs from the compensation PBMs receive in Medicare Part D plans, shifting towards a flat fee payment model.
Furthermore, the proposed reforms would have mandated that PBMs pass on all rebates to health plan sponsors, such as insurers and employers, in the commercial insurance market. The deal also aimed to eliminate the practice of 'spread pricing,' where PBMs withhold a portion of the payment they receive for drugs from pharmacies, particularly in Medicaid programs.
However, with the exclusion of these reforms from the latest GOP spending bill proposal, the future of PBM regulation remains uncertain. Many stakeholders had hoped that the bipartisan agreement would bring much-needed transparency and accountability to the PBM industry, but it seems that these changes will have to wait for another legislative opportunity.
