Senate introduces bipartisan PBM oversight bill that ‘prioritizes patients over profits’

The federal government would have more power to oversee pharmacy benefit managers under a bipartisan bill introduced in the U.S. Senate on Thursday.

The PBM Oversight Act of 2023, sponsored by Sen. Tom Carper, D-Del., and Sen. Chuck Grassley, R-Iowa, would give the Centers for Medicare and Medicaid Services the authority to oversee PBM decision-making. It also would require that PBMs submit detailed information to CMS each year that includes documentation of their interactions with recommendation committees, which are the groups that decide on what will be included in a formulary.

“Far too many Americans are forced to make the impossible decision of choosing between putting food on the table and paying for the medications that they need,” Carper said. “This is unacceptable. This bipartisan legislation will take a critical step forward toward rooting out the causes of the high costs for lifesaving medications. By holding pharmacy benefit managers accountable and establishing much-needed oversight of their practices, we will bring American patients back to the forefront of our medical system.”

PBMs also would be required to submit information about what drugs were selected and a justification for the decisions. The Government Accountability Office then would be tasked with studying this information and reporting its findings to Congress.

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“Pharmacy benefit managers, which operate in the shadows between drug companies and insurance plans, use complex and opaque schemes to push up the prices of drugs for consumers,” Grassley said. “This bill shines a light on these practices and prioritizes patients over PBM profits. Large health industry corporations are squeezing Americans’ pocketbooks for medications they need, and Congress must tackle this issue from multiple directions.”

Lawmakers on both sides of the aisle have scrutinized PBMs amid efforts to lower drug prices in the United States. The heightened attention on PBMs has led to dueling ad campaigns, with several health-care sectors calling on Congress to tamp down on the middlemen. PBM associations in turn have run ads pushing back on reform efforts and launched a record-setting lobbying push.

Grassley previously introduced the Pharmacy Benefit Manager Transparency Act with Sen. Maria Cantwell, D-Wash., which would empower the Federal Trade Commission to examine PBM business practices. He recently called on fellow Republicans to rally behind PBM reform.

“We’ve got to pass legislation,” Grassley said. “We can’t put up anymore with middle people between the companies and the consumer without knowing what they’re doing, particularly when they’re raking in a lot of taxpayer money.”