The Republican and Democratic leaders of the Senate Finance Committee have teamed up to bring back a major pharmacy benefit manager regulation bill.
Sen. Mike Crapo, R-Idaho, the committee chairman, and Sen. Ron Wyden, D-Ore., the highest-ranking Democrat on the committee, joined to introduce the “PBM Price Transparency and Accountability Act” bill.
The highly popular bill also has nine other Democratic cosponsors, in addition to Wyden, and 10 Republican cosponsors.
The bill would set detailed reporting requirements for PBMs that work with Medicare Part D prescription drug plans, requirement PBMs that serve Medicaid plans to pass Medicaid payments directly to pharmacies, and require public health plans to let patients use any pharmacies willing to meet the plans’ standard contract terms, according to a copy of the text posted by the Senate Finance Committee.
The bill does not mention employer-sponsored health plans and their PBMs.
A year ago, a similar public health plan PBM bill was moving through Congress in a package that included an employer plan PBM bill.
What it means: The reappearance of the public plan PBM bill could be a sign that a major new wave of health legislation is forming, and that the new wave could include the employer plan PBM bill, health account bills and other health benefits bills with solid bipartisan support.
The history: An earlier version of the public health plan PBM legislation was part of a 1,547-page continuing resolution deal that was supposed to keep spending constraints from shutting the federal government down.
The employer plan PBM section in the continuing resolution would have required a PBM serving a large fully insured employer health plan or a self-insured employer health plan to pass 100% of any prescription drug rebates or discounts on to the employer plan’s sponsor.
Another part of the employer plan PBM section would have set detailed reporting rules for employer plans’ PBMs.
Lawmakers ended up stripping both the public plan PBM section and the employer plan PBM section out of the final version of the continuing resolution that was ultimately signed into law, even though both PBM sections appeared to have strong bipartisan support.
Republicans in the House and Senate appeared to hint that PBM legislation would soon pass through some other avenue.
The new gameboard: Democrats in Congress recently lost a battle to put a provision extending the current, generous Affordable Care Act subsidies for individual and family health insurance past Dec. 31 in an anti-shutdown bill that President Donald Trump signed Nov. 12.
But Sen. Bill Cassidy, R-La., chairman of the Senate Health, Education, Labor and Pensions Committee, indicated at a committee hearing Dec. 3 that he still thinks Congress can pass legislation that would extend a high level of ACA subsidies for many individual and family coverage users.
Witnesses at the hearing, such as Joel White, president of the Council for Affordable Health Coverage, seemed to be hoping that any premium tax credit legislative efforts could include boosts for association health plans and individual coverage health reimbursement arrangements.