A key House committee this week advanced a bill that aims to inject some additional transparency into the pharmacy benefit management industry, the latest update in a broad congressional push for reform.
The bill would require PBMs to meet new transparency requirements and would ban spread pricing in Medicaid. The Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act mandates that PBMs compile annual reports for employers with a slew of key information, including their drug spending, out-of-pocket costs, rebates, formulary placement and acquisition costs.
The legislation earned unanimous approval in the Energy and Commerce Committee, and heads to the House floor. The committee's Subcommittee on Health advanced the bill last week.
“We are taking action to make the health care system more patient-friendly so that people can access health care when they need it and at a cost they can afford," Committee Chair Cathy McMorris Rogers, R-Washington, said in opening remarks.
Rogers is the bill's lead sponsor, and the measure is cosponsored by Ranking Member Frank Pallone, D-New Jersey.
In addition to the PBM components, the PATIENT Act would codify Trump-era regulations round price transparency for hospitals and insurers and extends funding to community health centers and graduate medical education.
Finding solutions to tackle rising drug costs has been a key focus in Congress of late, and PBMs have been a prime target for reform. A bill making its way through the Senate in parallel would ban spread pricing overall, despite objections from some Republicans.
Legislators have also held multiple hearings probing consolidation in the industry. PBM market share is concentrated among three large companies: CVS Caremark, Express Scripts and Optum Rx.