Another coalition of congressional lawmakers has united to introduce a new version of the Delinking Revenue from Unfair Gouging Act (DRUG Act) bill. Rep. Marianne Miller-Meeks (R-Iowa) and co-sponsors from both parties introduced the bill, which could impact how pharmacy benefit managers (PBMs) are paid.
Miller-Meeks unsuccessfully introduced a previous version of the bill during the 118th Congress.
PBMs assist employers and other health coverage providers in managing prescription drug benefits. Under the bill, PBMs working with health insurance coverage providers, including employers' self-insured plans, would be limited to charging flat fees for services. In other words, PBMs could no longer base their compensation on a percentage of retail or wholesale prices for prescription drugs.
The Pharmaceutical Care Management Association, which is the PBMs' trade group, claims that they are being targeted because they have slowed U.S. prescription drug spending to the same rate as other healthcare cost growth. According to PBM, other players in the prescription drug arena are unhappy because PBMs' actions have cut into their profit margins.
However, some critics, including Novo Nordisk, the maker of the weight-loss drug Wegovy, have accused the current pay structure for PBMs of pushing up drug prices. They state that basing PBM payment on the amount of the negotiated drug discount has caused drug manufacturers to increase their prices. When PBMs face higher retail prices, they can negotiate bigger discounts, increasing the share they receive as payment.
High retail prices don't affect most patients, who only must pay copays for covered drugs. However, those higher prices adversely affect patients who are paying out-of-pocket or using health savings or flexible spending accounts to purchase prescription drugs.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
