12 Dec Health Equity Collaborative Welcomes Bipartisan PBM Accountability Legislation
The Health Equity Collaborative welcomes bipartisan pharmacy benefit manager (PBM) accountability legislation recently introduced in Congress and encourages its swift consideration.
Earlier this month, U.S. Senate Finance Committee Chairman Mike Crapo (R-Idaho) and Ranking Member Ron Wyden (D-Oregon) introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act to address market distortions and increase transparency in federal prescription drug programs, with the goal of lowering patient costs at the pharmacy counter.
The challenges this legislation seeks to address are significant and directly impact the communities we serve. PBMs often prioritize higher-cost medicines when designing formularies, influencing both what patients pay out of pocket and which medicines they can access through their insurance coverage. When a drug is excluded from the formulary, insurers typically refuse coverage and physicians often decline to prescribe it—leaving patients with limited options.
Today, the three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—control approximately 80 percent of the entire PBM market and administer drug benefits for over 270 million Americans.
The ongoing trend of vertical integration and consolidation within the PBM industry is reshaping the pharmaceutical market in ways that can harm vulnerable populations. Patients and taxpayers—particularly those in underserved communities—deserve greater transparency regarding the systemic practices that impact the cost of their medicines and their access to care.
The PBM Price Transparency and Accountability Act would:
- Delink PBM compensation from negotiated rebates to reduce incentives for promoting higher-priced medications;
- Expand PBM reporting requirements to Medicare Part D plan sponsors and to the U.S. Department of Health and Human Services (HHS), while empowering plan sponsors to audit PBMs for contract compliance;
- Reinforce existing requirements that plan sponsors contract with any willing pharmacy meeting standard contract terms and conditions, helping to protect independent pharmacies in rural and underserved areas from practices that have contributed to widespread closures;
- Require retail community pharmacy participation in the National Average Drug Acquisition Cost (NADAC) survey to help ensure accurate Medicaid payments to pharmacies; and
- Mandate that PBMs pass Medicaid payments directly to pharmacies, promoting transparent drug costs for states and taxpayers.
The bipartisan coalition of co-sponsors includes Senators John Barrasso (R-Wyoming), Michael Bennet (D-Colorado), Marsha Blackburn (R-Tennessee), Catherine Cortez Masto (D-Nevada), Bill Cassidy (R-Louisiana), John Cornyn (R-Texas), Steve Daines (R-Montana), Maggie Hassan (D-New Hampshire), Ben Ray Luján (D-New Mexico), Tina Smith (D-Minnesota), Chuck Grassley (R-Iowa), Mark Warner (D-Virginia), James Lankford (R-Oklahoma), Raphael Warnock (D-Georgia), Roger Marshall (R-Kansas), Peter Welch (D-Vermont), John Thune (R-South Dakota), Sheldon Whitehouse (D-Rhode Island), and Thom Tillis (R-North Carolina).
The Health Equity Collaborative encourages Congress to thoughtfully consider and advance the PBM Price Transparency and Accountability Act. This legislation represents an important opportunity to protect patients, advance transparency in prescription drug markets, and help ensure that all Americans—particularly those in diverse and underserved communities—can access affordable, essential medications.