Lame Duck or Lost Cause? Opinions Vary on PBM Reform’s Prospects

  • Mar 14, 2024

    When President Joe Biden signed a $460 billion government funding bill on March 9, that legislation was missing something that numerous legislators and other stakeholders have long been pushing for: PBM reform.

    Depending on whom you ask, the omission either represents a temporary setback or a sign that it will be a long time before any federal legislation passes that successfully alters major PBMs’ much-criticized business practices.

    “There’s still incredible bipartisan, widespread support for action on these issues,” says Joe Shields, managing director of Transparency-Rx, a coalition of smaller PBMs pushing for reform measures targeting their industry-dominant rivals. “We expect there will be action on these issues; that action could be in a matter of weeks, at least from what I’m hearing of some cadence coming out of Capitol Hill.”

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  • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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