WASHINGTON, D.C. - Reps. Earl L. "Buddy" Carter (R-GA), Lisa Blunt Rochester (D-DE), Nicole Malliotakis (R-NY), and Jake Auchincloss (D-MA) introduced the Protecting Patients Against PBM Abuses Act to protect patients and pharmacies from harmful pharmacy benefit manager (PBM) practices that make high-quality health care inaccessible and unaffordable.
The bill accomplishes this goal by delinking PBM compensation from the cost of medications, banning patient steering and spread pricing, increasing transparency, and addressing conflicts of interest.
"PBMs prey on patients and independent pharmacies, driving up costs without providing any real value to patients and our health care system," said Rep. Carter. "This strong legislation will shield the millions of victims from PBM abuse and predatory pricing techniques that take advantage of patients and bleed pharmacies dry."
"One of my top priorities since coming to Congress has been lowering the cost of health care for everyday Americans. Many factors contribute to high health care costs, and one of the most insidious are the opaque practices of Pharmacy Benefit Managers or PBM's," said Rep. Blunt Rochester. "That's why I'm proud to join Rep. Carter in introducing the Protecting Patients Against PBM Abuses Act to realign incentives and ensure that PBMs aren't raising prices on consumers to rake in record profits and increasing transparency so that patients, plans, and other stakeholders can make informed decisions about their health care."
"When it comes to PBMs, there’s little to no transparency on their practices, and they’re making a lot of money by dictating what their competitors are able to make," Congresswoman Nicole Malliotakis said. "Because of this, ‘Mom & Pop’ pharmacies in my district are being crushed, and the costs are being passed down to consumers. I’m proud to join my colleagues in introducing this critical piece of legislation which cracks down on the exploitative pricing techniques of PBMs and works to make pharmaceuticals more affordable."
"Patients deserve the best drugs at the lowest costs and pharmacies deserve the right to do business without the hassle of middlemen looking to make a cheap buck. This bill enforces transparency and removes the incentives PBMs have to steer patients towards higher priced drugs. It's time to crack down on the middlemen who are making drug costs higher at the pharmacy counter," said Rep. Auchincloss.
Specifically, the Protecting Patients Against PBM Abuses Act will:
- End PBMs' misaligned incentives that are driving up prices and costs for patients by delinking PBM compensation from the cost of medications.
- Prohibit the PBM from compensating a network pharmacy less than affiliated pharmacies.
- Prohibit spread pricing, where the PBM charges the sponsor a different amount for the drug’s ingredient cost or dispensing fee than the amount the PBM reimburses the pharmacy for such ingredient cost or dispensing fee.
- Increase transparency on data related to PBM rebates (including how much or little is passed through to the Part D sponsor) and administrative fees will help plan sponsors, government agencies, researchers and the public understand how rebates and fees are impacting costs on a plan-level basis.
- Address PBMs' conflict of interest to a Part D plan’s pharmacy and therapeutics (P&T) committee.
Read the full bill text here.
Read the legislative summary here.
Read Rep. Carter’s report on unethical PBM practices here.
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