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The next drug pricing battle: PBMs

Axios


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.


About the Author: Victoria Knight, author of Axios Pro Policy

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