PBMs in the Hot Seat: Scrutinizing and Regulating the Industry

Pharmacy benefit managers (PBM), which act as middlemen that help set formularies and drug prices, have faced a wave of US congressional scrutiny in recent months. This includes hearings, committees, and even legislation. In a new Mintz article, catch up on all the latest updates on federal activities targeting the industry and its practices.

According to Bridgette A. Keller and Sophia Temis, “On April 25, 2023, Congresswoman Diana Harshbarger (R-TN) introduced a bipartisan bill that would increase the reporting requirements of PBMs across all health insurance markets. If enacted, the Pharmacy Benefit Manager Sunshine and Accountability Act would amend Section 1150A of the Social Security Act to expand PBM transparency and include public reporting requirements. The proposed bill would require PBMs to provide, and for HHS to annually publish on its website, information on (i) the aggregate dollar amount of all rebates, administrative fees, and any other revenue received from drug manufacturers, health insurers, or plan sponsors, including the dollar amount of all rebates and administrative fees received but not passed through, (ii) highest, lowest, and total aggregated retained rebate percentages, and (iii) post-adjudication payments, including any fees, reimbursements or other claw backs that PBMs collect from pharmacies.”

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(Source: Mintz, June 15^th, 2023)