Congress Eyes Major PBM Reforms in Year-End Spending Bill

Bipartisan Momentum:
There is significant bipartisan support in Congress for reforming Pharmacy Benefit Managers (PBMs) to address rising healthcare costs124.

Legislative Proposals:
Several bills, including the Lower Costs, More Transparency Act (H.R. 5378), the Modernizing and Ensuring PBM Accountability Act (S. 2973), and the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (S. 3430), aim to reform PBM practices by banning spread pricing, increasing transparency, and requiring detailed reporting on pricing and rebates12.

Savings Projections:
The Congressional Budget Office estimates that these reforms could save the federal government between $700 million and $3 billion over ten years1.

Year-End Action:
Lawmakers are pushing for these reforms to be included in the year-end spending bill, emphasizing the need for immediate action to address healthcare costs and protect patients245.

Transparency and Competition:
The reforms also aim to enhance price transparency and operational transparency in the healthcare industry, including strengthening current price transparency rules for health plans and hospitals2.

Telehealth Extensions:
Alongside PBM reforms, there is also a push to extend pandemic-related telehealth flexibilities, which are set to expire on December 31, 202423.

Sources:

1. https://www.crfb.org/blogs/pbm-reform-horizon-pharmacy-benefit-manager

2. https://www.mercer.com/en-us/insights/us-health-news/healthcare-leftovers-pile-up-for-year-end-congressional-menu/

3. https://gi.org/2024/10/24/end-year-congress-update-reimbursement-pbm/

4. https://nam.org/bipartisan-legislators-pass-pbm-reform-now-32797/

5. https://healthequitycollaborative.org/congress-pass-end-of-year-pbm-reform-to-ensure-a-more-equitable-healthcare-system/