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Another bill aims at PBM pricing and management


Senators formally introduce act that has been in discussion since summer.

stack of money and pills: © DedMityay - stock.adobe.com

© DedMityay - stock.adobe.com

Federal lawmakers have drafted more legislation that would create greater oversight and regulations for pharmacy benefit managers (PBMs).

The Modernizing and Ensuring PBM Accountability Act (MEPA) would bring more transparency and competition to the pharmaceutical supply chain, according to Senate Finance Committee Chair Sen. Ron Wyden (D-Oregon) and Ranking Member Sen. Mike Crapo (R-Idaho). They introduced the bill to take on “health care middlemen that are driving up costs for seniors and taxpayers,” Wyden said in a news release.

Sen. Ron Wyden (D-Oregon)

Sen. Ron Wyden (D-Oregon)

“Senator Crapo and I are committed to continuing our work with members of the committee who are interested in including additional policies beyond those in this bill,” Wyden said. “I look forward to continuing our work, passing this into law and curtailing the PBM practices that are keeping drug prices high.”

Crapo called it “commonsense, bipartisan legislation” that would ensure seniors can access pharmacies of their choice, including in rural areas.

Sen. Mike Crapo (R-Idaho)

Sen. Mike Crapo (R-Idaho)

“The comprehensive proposals included in this bill will enhance oversight of pharmacy benefit managers and improve incentives across Medicare and other federal health programs,” Crapo said. “Moving forward, we will continue to build on this foundation through additional priorities from Senators across the Finance Committee to promote pharmacy access, strengthen accountability, and reduce out-of-pocket costs for patients.”

Among its provisions, MEPA would:

  • Prohibit pharmacy benefit manager compensation in Medicare from being tied to the sticker price of a drug.
  • Increase transparency by creating independent audit and enforcement measures.
  • Provide relief to independent community pharmacies that are often on the receiving end of PBM business practices that are harmful to their business.

Giveaway to big pharma?

The Pharmaceutical Care Management Association (PCMA) ripped the legislation as “a $10 billion giveaway to big pharma,” in a news release issued specifically about the MEPA Act.

Changing the pricing structure by “de-linking” compensation and drug costs would end PBM incentives to maximize market competition that brings down prices for patients and health plan sponsors, according to PCMA.

The association has promoted findings that the current pricing system saves payers and patients $1,040 per patient per year. That result was part of “Ending Pay for PBM Performance: Consequences for Prescription Drug Prices, Utilization, and Government Spending,” a working paper published by the National Bureau of Economic Research.

Ones to watch

This month, analyst Patrick Cooney, president of The Federal Group, said the legislation was one of four bills to watch in the Senate and House of Representatives.

“On the heels of the Inflation Reduction Act, PBM legislation has blossomed,” Cooney said at the PBMI Annual National Conference in Orlando.

Additional pending legislation about PBMs includes the Pharmacy Benefit Reform Act, adopted by the Senate Committee on Health, Education, Labor and Pensions; the Pharmacy Benefit Manager Transparency Act of 2023, considered by the Senate Committee on Commerce, Science and Transportation; and the House PATIENT Act of 2023.

Cooney predicted the legislators would package various elements of the bills into a single bill addressing pandemic-related issues, Medicare, Medicaid, and a range of other health care concerns, as reported in Managed Healthcare Executive, a sister publication of Medical Economics.

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