A group of lawmakers maintain legislation they have introduced would address pharmacy benefit managers (PBMs) compensation and aid in lowering prescription drug prices.
U.S. Sens. Ron Wyden (D-OR), chairman of the Senate Finance Committee, and Mike Crapo (R-ID), committee ranking member, recently joined U.S. Sens. Bob Menendez (D-NJ), Marsha Blackburn (R-TN), Jon Tester (D-MT) and Roger Marshall (R-KS) to detail the Patients Before Middlemen (PBM) Act
The legislation would delink PBM the compensation from drug price and utilization in order to better align incentives to assist with lowered prescription drugs costs for Medicare Part D beneficiaries.
“This legislation will put a stop to one of the most egregious practices driving up the price of prescription drugs in Medicare: pharmacy benefit managers getting paid based on the price of a drug,” Wyden said. “Instead of fighting for lower prices, this practice has encouraged drug middlemen to favor higher-priced drugs in their negotiations, which means seniors are forced to pay more for their prescriptions.”
Bill provisions include ensuring service fees will not be connected to the price of a drug, discounts, rebates or other fees and establishment of an enforcement mechanism requiring PBMs to pay to the Secretary any amount in excess of the designated service fees.
“As we work to find solutions that reduce prescription drug costs for patients at the pharmacy counter, this commonsense proposal will help mitigate misaligned incentives that currently steer some Medicare Part D plans, pharmacy benefit managers and seniors toward higher-priced medications, even when more affordable alternatives like biosimilars are on the market,” Crapo said. “Delinking PBM compensation from sticker prices would take a critical first step in ensuring that all supply chain participants seek out the best deals available, driving down out-of-pocket spending and promoting cost-cutting competition.”