PBM Rules Dropped From Senate Passed Version of Trump's Bill

The policy would have prevented PBMs from having their compensation linked to the list prices of medications.

WASHINGTON — A pharmacy benefit manager provision that was in the original House “Big Beautiful Bill” was removed from the Senate version when the bill narrowly passed last Tuesday. That provision, which would have placed additional rules on them, was included in the House version.

The final “Big Beautiful Bill”, signed by President Trump last week, omits a pharmacy benefit manager (PBM) reform provision that was included in the House version but removed by the Senate before passage. The provision would have prevented PBMs from tying their compensation to the list prices of medications and would have banned “spread pricing,” where PBMs charge health plans more for a drug than they pay pharmacies and keep the difference as profit.

Instead, the proposal would have required “pass-through pricing,” reimbursing pharmacies for the ingredient cost plus a professional dispensing fee while limiting PBMs to administrative fees. Supporters, including the National Community Pharmacists Association, argued that the change would align Medicaid managed care payments with the National Average Drug Acquisition Cost and state Medicaid dispensing fees, saving taxpayers nearly $3 billion.