Axios Pro Exclusive Content

PBM requirements used as pay-for by W&M

headshot
May 8, 2024
The Capitol dome on top of a pill bottle

Illustration: Sarah Grillo/Axios

One of the big pay-fors on the House Ways and Means' telehealth extension is the projected savings from delinking and transparency requirements on PBMs.

Why it matters: It's another sign of eagerness to crack down on PBMs, after some provisions were almost included in the March government funding package.

Zoom in: This telehealth package includes PBM transparency measures similar to those in the House's health cost transparency package.

  • It also includes a "delinking" requirement that PBMs only receive income from service fees, and do not receive incentive payments unless they are flat fees.
  • This is modeled on parts of the Protecting Patients Against PBM Abuses Act from Reps. Buddy Carter, Lisa Blunt Rochester, Nicole Malliotakis and Jake Auchincloss.
  • The bill doesn't go so far as banning spread pricing for PBMs — a proposed change that has legs in the Senate.

The other side: The PBM trade group PCMA said the requirements shouldn't be used to offset the cost of the package and amount to a bailout for big drugmakers.

  • "The pharma-backed "delinking" policy included in the legislation by the committee does nothing to lower prescription drug costs but would saddle seniors with higher premiums while boosting profits for big drug companies by $10 billion each year," PCMA spokesperson Greg Lopes told Axios.
Go deeper