President-elect Donald Trump. Credit: White House
This article has been updated to reflect events that have occurred since the original publication time. For newer coverage of the American Relief Act, 2025 package, see President signs anti-shutdown package, with no PBM provisions.
A big, "must pass" House package that included new rules for employers' pharmacy benefit managers stalled, and House Republicans replaced it with a much shorter package that left out any PBM provisions.
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Members of the House voted 366-34 around 6.p.m. Friday evening to pass an American Relief Act, 2025 bill that excludes the PBM provisions.
Members of the Senate voted 85-11 around 12:50 a.m. Saturday morning to pass the package and send it to the desk of President Joe Biden for his signature.
Biden signed the bill Saturday.
The government was set to shut down at midnight Friday, when many federal offices were closed for the weekend. Senate Majority Leader Charles Schumer, D-N.Y., said as Senate debate started that he believed the ARA, 2025 package would pass quickly enough to prevent any meaningful shutdown. White House officials said they had ended efforts to implement a shutdown.
The ARA, 2025 package authorizes the government to stay open until March 14, 2025.
The employer PBM sections in the original anti-down package: The employer PBM provisions in the 1,547-page "Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025", which showed up on the House website Tuesday, would require PBMs to pass all rebates or discounts they negotiated for employer-sponsored health plans on to the employer plans.
Another, related provision would have require PBMs to send employers detailed reports on drug wholesale costs, discounts, rebates and patients' net costs for each drug a plan covers.
Dr. Wayne Winegarden, director of the Center for Medical Economics and Innovation at the Pacfic Research Institute, an independent research center that has traditionally been popular with conservative Republicans, said via email that he thinks the reporting requirements included in the employer PBM sections look reasonable and would promote needed transparency.
"The requirement that all discounts be passed along to insurers is an improvement," Winegarden said. "Ideally reforms should ensure that the out of pocket costs of the patients purchasing the drugs reflect these discounts as well."
Danny Sanchez, chief executive officer of EmpiRx Health, a smaller PBM that emphasizes efforts to be transparent and support local pharmacists, praised the employer PBM section.
"I am surprised, and pleased, to see this push from lawmakers to put much-needed constraints on the self-dealing business practices of the largest PBMs," Sanchez said via email. "Forcing PBMs to disclose costs, fees and reimbursements will bring much-needed transparency to the process, which will allow plan sponsors to make the best decisions for their members and organizations."
Related: New 'must pass' House package includes employer plan PBM section
The Financial Continuing Appropriations legislation is now dead, but the appearance of the PBM provisions in the package sshows that the idea of tightening the rules governing PBMs has broad support from both Republicans and Democrats in Congress.
Trump himself has talked for years about wanting to take on the pharmaceutical industry.
Congressional leaders could still save the employer PBM sections in the current Further Continuing Appropriations package by bringing the deleted provisions back, in or more bills, in the 119th Congress, which begins Jan. 3.
The rest of the Further Continuing Appropriations package: Some of the other major parts of the Further Continuing Appropriations package would stabilize current Medicare program funding; reauthorize the Older Americans Act, which pays for 900,000 meals for elderly people per day; and provide funding for national health security and cybersecurity programs.
The legislating: House leaders began the public debate on anti-shutdown package specifics Tuesday, by posting the Further Continuing Appropriations act text.
President-elect Donald Trump objected to the package in a comment posted on the Truth Social social media service Wednesday.
Whatever Congress passes should include an increase in the federal debt ceiling, which is now set to choke off federal borrowing in June, and any move to pass a package without a debt ceiling increase is a trap, Trump said in the post.
"Any Republican that would be so stupid as to do this should, and will, be primaried," Trump posted.
Trump did not mention the provisions in the Further Continuing Appropriations package that refer to the employer PBM sections or to federal health programs, such as Medicare.
House leaders posted a 116-page substitute, a version of the American Relief Act, 2025 package, Thursday. That version would have provided a temporary extension of the public debt limit and let the government continue to borrow money by issuing bonds.
House members voted 174-235 Thursday against letting House leaders rush the first ARA, 2025 package to the House floor.
House leaders then replaced the first ARA, 2025 package with a second, 118-page version that excludes the public debt limit provision. All Democrats and most Republicans in the House voted for the second version of the ARA, 2025 package. All House members who voted against it were Republicans.
The Senate began considering the package after passing H.R. 82, the Social Security Fairness Act of 2025, by a 76-20 vote. That bill changes federal laws that have kept some public sector retirees and family members from collecting Social Security benefits.
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