Targeting Just Part D, New Bill Checks Another Item Off PBM Critics’ Wish List

The Senate Finance Committee recently introduced a bill that adds to a growing swell of legislation aimed at changing how PBMs conduct business. This latest measure, which is focused solely on Medicare Part D, aims to delink PBM compensation from drug list prices and utilization. Industry experts say it is meant to complement, rather than compete with, other legislation that targets a broader range of business practices and insurance markets. 

The Patients Before Middlemen (PBM) Act, introduced on June 14, targets just Medicare Part D because that program is where the Senate Finance Committee’s jurisdiction lies, explains James Gelfand, president and CEO of the ERISA Industry Committee (ERIC). And based on the Senate Health, Education, Labor and Pensions (HELP) Committee’s jurisdiction, the legislation that it advanced in May — the Pharmacy Benefit Manager Reform Act — would apply just to employer-based health plans and address issues such as rebate retention and spread pricing.