Bipartisan Interest in Changing PBM Business Practices Continues to Grow

The year after President Joe Biden signed the Inflation Reduction Act (IRA) into law, policymakers have now focused their efforts on PBMs and their business models. Members of Congress on both sides of the aisle have introduced multiple bills focusing on issues such as the lack of transparency into PBM practices, spread pricing, direct and indirect remuneration (DIR) clawbacks, rebates and anticompetitive behavior. And some industry experts say they are hopeful that such legislation could improve transparency around drug pricing, including in the high-cost specialty arena.

There was much talk but little action around bringing down prescription drug prices during the previous administration, which floated tactics such as implementing a most-favored-nation model that would have tied drug prices in Medicare Parts B and D to other countries’ prices, lowering prices for insulin and distributing $200 prescription drug credits to Part D beneficiaries.