Bi-partisan pharmacy benefit manager (PBM) reform bill gets endorsement from AARP

Chances seem to be increasing that Congress will enact legislation in the coming weeks to address profiteering by the nation’s pharmacy benefit managers, the biggest of which are owned by large, for-profit insurance corporations. (PBMs owned by Cigna, where I worked, UnitedHealth Group and CVS/Aetna control 80% of the market.)

One PBM reform bill, sponsored by Reps. Buddy Carter (R-Georgia) and Lisa Blunt Rochester (D-Delaware), would help Medicare beneficiaries by changing some of the industry’s most egregious business practices. Their bill has made it through the important Energy and Commerce Committee, and similar legislation is working its way through the Senate. 

Last week, the legislation got a big boost when AARP put its considerable weight behind it. In a letter to Carter and Blunt Rochester, AARP’s Bill Sweeney, senior vice president for government affairs, expressed support for the “bipartisan efforts to advance policies to address practices in the prescription drug market that can contribute to high prices for consumers and taxpayers.”

AARP’s full letter to Reps. Buddy Carter (R-Georgia) and Lisa Blunt Rochester (D-Delaware).

Sweeney went on to say that:

Currently, some pharmacy benefit managers (PBM) fees are linked to drug prices, which could incentivize PBMs to cover high-priced drugs instead of lower-priced alternatives. Your legislation would de-link PBM compensation from drug prices and instead require Medicare Part D plans to pay PBMs using flat-dollar service fees. It will also address the possibility of PBMs receiving price-based compensation from other entities in the prescription drug supply chain. AARP believes that this would help reduce potentially misaligned incentives that could contribute to higher costs for Medicare Part D enrollees.”

For a more in-depth look at what Congress is considering–and why–take a look at this piece I wrote last year.

The bipartisan support for PBM reform is real, as I noted last month in this piece about how both conservative and liberal advocacy groups are calling for reform. 

You might also want to take a look at this interview I did with Rep. Carter, a pharmacist, in late 2022, to get an understanding of what pharmacists have to deal with day in and day out because of PBM practices that imperil their businesses and saddle millions of America’s seniors with sky-high deductibles and other out-of-pocket expenses.

I also recently met with another pharmacist who is now a member of Congress, Rep. Diana Harshbarger. In the coming weeks, I’ll be writing about why she also supports PBM reform. Harshbarger, by the way, represents Tennessee’s First Congressional District, where I grew up. As it turns out, we lived just a couple of miles apart (in Kingsport’s Bloomingdale neighborhood) back in the day.