The next drug pricing battle: PBMs
The pharmaceutical lobby took its hit with the Medicare drug price negotiation bill. Next in line: pharmacy benefit managers.
Why it matters: Even if the midterm elections result in a split Congress, PBMs seem to be one of the few drug pricing bipartisan agreement points between the two parties.
What we're watching: Rep. Buddy Carter (R-Ga.) told Axios that if Republicans win the House, he’s asked leadership to make PBM reform the subject of one of the first 10 bills in the new Congress.
- Carter, who is a pharmacist, has also recently formed a new bipartisan caucus to address PBMs, saying it’s so new “it hasn’t been named yet,” that will announce more policy proposals next year.
- There's even a bipartisan bill by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) that could move during this year's lame duck.
- It's aimed at insulin costs, but it has a provision that would ensure PBMs cannot collect rebates on insulins that limit list prices to the 2021 net price for Medicare Part D or equivalent levels.
Between the lines: Republicans have long sided with the pharmaceutical industry on the need to rein in what they say are PBMs' profit-driven practices.
- But it's not just Republicans. If Democrats keep the Senate, Sen. Ron Wyden (D-Oregon), chair of the Finance Committee, will make investigating PBMs role in the market a priority in the next Congress, one of his staffers told Axios.
- And a federal agency is now involved: The Federal Trade Commission announced in June it was launching an inquiry into the business practices of PBMs.
The other side: The Pharmaceutical Care Management Association, the lobbying group for the industry, is sticking to its line that drug companies are the ones to blame for skyrocketing drug costs, not PBMs.