Legislation providing more scrutiny for pharmacy benefit managers (PBMs) that failed to make it through Congress in the waning days of 2024 seems to still be viable for passage this year, according to a House staff member.
"I think there's plenty of political will there; that's what I've seen from members," Preston Bell, a professional staff member on the House Ways & Means Committee, said Thursday at an eventopens in a new tab or window sponsored by the American Enterprise Institute (AEI) on the future of the Medicare prescription drug benefit. "I do think there are disparate ideas across Congress as to how much intervention within the PBM market is appropriate. What you've seen come through Congress in the final package is probably the litmus test, or maximum, of what is feasible for that type of reform."
Last year's PBM bill -- which appeared poised for passage until President Trump adviser Elon Musk intervened -- would have requiredopens in a new tab or window that PBMs provide detailed data on drug spending to group health plans, and also that they pass along 100% of drug rebates and discounts to the employer or health plan they negotiate on behalf of. The legislation also required CMS to define "reasonable" contract terms for Medicare Part D drug plans, and to allow "any willing pharmacy" to serve Medicare patients. It also barred PBMs from tying their compensation to a drug's Medicare price.
But after Musk called the original budget deal "outrageous,"opens in a new tab or window the PBM provisions were removed from the bill along with many other provisions, including one that would have largely reversed a cutopens in a new tab or window to the Medicare Physician Fee Schedule.
"One of the strongest things we can do is a transparency piece for the employer market, which will provide employers a lot more information about the drug benefit," Bell said. "That will enable them to better understand their benefit and focus on where they can find savings ... There is still an opportunity this year to do that; there is no reason why the calculus would have changed. I wouldn't expect that the political will has gone away at all."
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