July 13, 2023 - Modern Healthcare
Lauren Berryman
Yet another congressional committee has advanced legislation aimed at bringing down prescription drug prices by imposing new rules on pharmacy benefit managers.
On Wednesday, the House Education and the Workforce Committee advanced four bills requiring new disclosures from PBMs, health insurance companies and hospitals about healthcare costs. The panel unanimously approved the Transparency in Billing Act of 2023, while all but one member voted to approve the Transparency in Coverage Act of 2023, Health DATA Act of 2023 and Hidden Fee Disclosure Act of 2023.
The bills seek to improve price transparency for prescription drugs and medical services. They would also mandate that PBMs and third-party administrators share compensation data with health plan fiduciaries, and that fiduciaries receive cost and quality of care information about health plans.
“Dishonest billing, opaque rules and shady industry practices have left patients paying higher costs for healthcare," Education and the Workforce Committee Chair Virginia Foxx (R-N.C.) said in a news release Wednesday. "Today's passage of our bipartisan healthcare package makes great strides towards giving clarity to patients and building a healthcare system that is more transparent, affordable and accessible.”
PBMs are under fire in Washington, both on Capitol Hill and from the Federal Trade Commission.
The action from the Education and the Workforce Committee follows the unanimous passage of similar legislation, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023, by the House Energy and Commerce Committee in May. That bill would require PBMs to provide annual reports to employer clients revealing prescription drug spending, acquisition costs, out-of-pocket expenses, formulary placement and rebates.
Two powerful Senate panels are also tackling drug prices and PBM transparency through legislation that would go much further than the House bills.
The Senate Health, Education, Labor and Pensions Committee approved the Pharmacy Benefit Manager Reform Act of 2023 on a bipartisan vote in May. That legislation would ban spread pricing, require PBMs to pass along pharmaceutical rebates to employers and policyholders, and mandate greater financial transparency.
Senate Finance Committee Chair Ron Wyden (D-Ore.) and ranking member Mike Crapo (R-Idaho) plan to hold a markup on PBM legislation on July 26 that follows their release of a policy framework in March.
On Wednesday, Wyden, Crapo and Sens. Catherine Cortez Masto (D-Nev.) and Thom Tillis (R-N.C.) debuted the Medicare PBM Accountability Act of 2023, which would require companies to report information such as prices and rebates under Medicare Part D. Last month, Sens. Robert Menendez (D-N.J.) and Marsha Blackburn (R-Tenn.) introduced the Patients Before Middlemen (PBM) Act of 2023 with support from Wyden and Crapo. This bill would prohibit PBMs from incorporating fees and drug company rebates into prescription prices for Medicare Part D plans.
PBMs are under at least two federal investigations. House Oversight and Accountability Committee Chair James Comer (R-Ky.) sent letters in March to CVS Health subsidiary Caremark, UnitedHealth Group subsidiary OptumRx and Cigna subsidiary Express Scripts requesting information about how they design formularies and collect rebates. And the FTC launched a probe into the industry's practices last year that has expanded to include scrutiny of group purchasing organizations affiliated with PBMs.