Illustration: Sarah Grillo/Axios
The outcome of this election could turn health policy on its head, but one thing's fairly certain no matter who wins: PBMs will remain in the spotlight.
Why it matters: Because of the bipartisan scrutiny of PBMs, legislation that would change their business practices to lower drug costs has a better chance of advancing.
Between the lines: PBM reform has forged some unusual coalitions in Congress.
- Whether the Senate Finance Committee is chaired by Mike Crapo or Ron Wyden next year, they're both sponsors of the panel's PBM legislation.
- Over at the Senate HELP Committee, Bernie Sanders and Bill Cassidy have similarly come together on a PBM bill, despite their multiple clashes on other matters over the last two years.
- And the House passed its transparency bill, which included PBM reporting requirements, with a bipartisan 320–71 vote.
Driving the news: On the presidential front, Vice President Harris' economic plan includes "cracking down on pharmaceutical middlemen that increase prices by limiting competition."
- Mark Cuban, a sharp critic of PBMs, has been a prominent campaign adviser.
- Former President Trump's health care plans have been murky, but as president he did put forward a rule, opposed by PBMs, to ban rebates. The policy never went into effect and has been repeatedly delayed by Congress.
The other side: PBMs argue that the scrutiny is misplaced and should be directed at drug manufacturers.
- "The price is the problem, and only Big Pharma can set the price," said Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association.
Yes, but: PBM reforms still are not a lock, despite the bipartisan sentiment.
- A flurry of competing proposals across different committees makes it difficult to settle on one final product.
- Proposed changes with the most traction include "delinking" the price of a drug from PBM compensation, requiring 100% of rebates to be passed to the plan sponsor, and new transparency requirements.
The bottom line: It is possible that some PBM overhauls even get done in the lame duck session.
- But that would likely require a significant health care package to be assembled, which has been elusive this Congress.
- If it doesn't happen, the specter of higher drug costs could give lawmakers an early rallying point next year, no matter the partisan makeup.
