PBM legislation passes House Energy and Commerce Committee

Pharmacy benefit managers would be required to report more information on their deals with pharmaceutical companies under legislation unanimously approved by a House panel on Wednesday.

The House Energy and Commerce Committee advanced the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023, sponsored by Chair Cathy McMorris Rodgers (R-Wash.) and ranking member Frank Pallone (D-N.J.), on a 49-0 vote. The panel’s health subcommittee cleared the same measure last week.

“This bill will tell patients the price they will pay for care, who owns their doctors’ office and how much pharmacy benefit managers are making off of their medicine,” McMorris Rodgers said during committee deliberations.

The bill would require PBMs to create reports for employer clients each year that detail prescription drug spending, acquisition costs, out-of-pocket expenses, formulary placement and rebates. In addition, the Government Accountability Office would produce a report on group health plan pharmacy networks, including those that health insurers own.

PBMs are under pressure in Washington as policymakers seek to address rising prescription drug prices.

In addition to the Energy and Commerce panel’s legislation, the House Oversight and Accountability Committee launched an investigation into PBM business practices in March. In the Senate, the Health, Education, Labor and Pensions Committee approved a bipartisan bill this month that would go beyond the House measure by banning spread pricing and requiring PBMs to pass along drugmaker rebates to clients and patients, reveal the prices they negotiate for medicines, disclose the fees they pay pharmacists to dispense prescriptions, and report how much they earn from drugmaker rebates.

These congressional efforts coincide with executive actions. On Tuesday, the Centers for Medicare and Medicaid Services announced a proposal to require PBMs to disclose the prices they pay for medications under Medicaid. And the Federal Trade Commission this month widened the scope of its year-long investigation of PBMs such as CVS Health’s CVS Caremark, UnitedHealth Group’s OptumRx and Cigna’s Express Scripts to include group purchasing organizations affiliated with such companies.