Radar on Drug Benefits

Senate HELP Panel PBM Bill Requires Rebate Pass-Through, but not to Plan Members

  • Apr 27
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    Apr 27, 2023

    Pharmacy benefit manager reform legislation co-authored by Senate Health, Education, Labor and Pensions Committee chair Bernie Sanders (I-Vt.) and ranking member Bill Cassidy (R-La.) addresses the hot-button issue of rebates but not in the way biopharma manufacturers are hoping for.

    It would require PBMs to remit “100% of rebates, fees, alternative discounts and other remunerations received…that are related to utilization of drugs under such health plan or health insurance coverage to the group health plan.” Biopharma companies have for years been pushing for a policy that mandates rebates be passed through, not with health plans as envisioned by the legislation, but with plan enrollees at the point-of-sale as a better way to “share the savings.”

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    • Cathy Kelly

    Cathy is a senior writer with Pink Sheet and has covered U.S. regulation and reimbursement policy for the biopharma industry since 2004, starting with the establishment of the Medicare Part D program. Since then, she has written extensively about developments in all major sectors of the U.S. insurance market (Medicare, Medicaid and commercial plans). She has covered key legislation affecting biopharma, including the Medicare Prescription Drug, Improvement, and Modernization Act which created Part D, health care reform under President Obama, and the Inflation Reduction Act. She has closely followed the increasing influence of pharmacy benefit managers and their use of formulary negotiations and rebates to control pricing. Cathy also has covered developments in health technology assessments and has monitored industry progress on novel drug contracting that reflects value-based pricing.

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