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Another powerful congressional committee is ready to take on PBMs

Stat News
April 26, 2023
By John Wilkerson


WASHINGTON — House Oversight Committee Chairman James Comer plans to hold a hearing on the results of an investigation into the business practices of drug middlemen, he said Wednesday.

Comer is not a fan of pharmacy benefit managers. The Kentucky Republican represents a rural part of the state, and independent pharmacists in rural areas tend to be vehemently opposed to some PBM business practices.

“I intend to prove that PBMs are intentionally reimbursing competing pharmacies like you less than they are paying pharmacies they own,” Comer said to a packed audience of pharmacists who gave two standing ovations.

Comer announced the oversight hearing, which has yet to be officially scheduled, during an event sponsored by the National Community Pharmacists Association. Comer launched an investigation into PBMs this year after taking control of the committee. He said the hearing will be bipartisan.

“Katie Porter is someone that I hope will play a big role on their side in this hearing,” he said, referring to the California Democrat firebrand.

There’s a wave of bipartisan congressional activity in both the House and Senate on pharmacy benefit managers. The Senate health committee will markup bills that would ban so-called spread pricing and require PBMs to disclose information about deals with drug makers. The Senate Finance Committee last week released an outline of legislative priorities for reforming PBM practices, and last month the Senate Commerce Committee passed a bill that also is aimed at PBM transparency. Senate Majority Leader Chuck Schumer is expected to roll at least some of those policies into a broader health care bill he’s hoping to move this year.

In the House, the Energy & Commerce Committee is holding a hearing today on PBM reform bills, and Senate Finance Committee chair Ron Wyden (D-Ore.) said he had spoken to Ways & Means Chair Jason Smith (R-Mo.) about coordinating on legislation.

Pharmacies are not the only focus of that activity. Lawmakers also say the middlemen are in part to blame for high drug prices across the board, running up costs for patients, employers and government programs.

The Pharmaceutical Care Management Association is fighting back. The PBM trade group more than doubled spending on lobbying between 2019 and last year, and it spent $2.76 million in the first quarter of this year, the most ever for the group.

PCMA also held a policy conference this week. PCMA President JC Scott said PBMs champion transparency and their market-based approach to negotiation keeps net prices stable and ensures patients and employers have choices.

“Despite all the rhetoric and all the advertisements we see and all the focus in Washington on our industry, our private market system is actually working pretty well for the vast majority of patients,” he said.

PBMs were spared last year when Democrats passed legislation directing Medicare to negotiate prescription drug prices. That law even helped the industry by delaying a Trump-era regulation that would undermine the ability of PBMs to negotiate rebates with drug makers.

“We heard rumors coming into this year that it would be the turn for PBMs to be in the spotlight,” Scott said. “And I feel comfortable confirming those rumors are true.”


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