Transparent PBMs form coalition to advance industry reforms

As pharmacy benefit managers and drug manufacturers once again sparred on the Hill, a group of transparent PBMs revealed that they had come together to form a coalition that drives industry reform.

The group, called Transparency-Rx, will push for changes to the PBM model that would likely ruffle feathers at the industry's biggest companies. These include a ban on spread pricing as well as reforms to the rebate model that include the impact of group purchasing organizations.

Other core tenets backed by the coalition include instituting a 100% pass-through model for discounts, "delinking" that requires PBMs to be paid by a disclosed flat fee and technology that backs data sharing with patients, insurers, pharmacists and other stakeholders.

Joseph Shields, managing director of Transparency-Rx, said its founding members are companies that are "looking to have a voice in the drug pricing debates and reform efforts."

"The notion that transparency is a dangerous idea, to us is sort of a little absurd—it's already working," he said. "The question is, can Congress help empower it and take it to scale for a variety of different plans?"

The initial coalition members represent 14.5 million lives across all 50 states, and Transparency-Rx is looking to continue to add new voices. Its founding members include AffirmedRx, Liviniti, MedOne Pharmacy Benefit Solutions Rx, Navitus Health Solutions, RxPreferred Benefits and SmithRx.

“Congress should know patients, employers and plans can thrive in a transparent, competitive, and efficient PBM market," LeAnn Boyd, CEO of Liviniti, said in the press release. "We embrace critical reforms to a costly and misaligned drug pricing market. In fact, most of these reforms are already reflected in the business and innovations of transparent PBMs.”

Many of the reforms championed by Transparency-Rx have legs in Congress, and policymakers have 43 different bills in play with policy changes in both the commercial and public sectors. The coalition is working with lawmakers on both sides of the aisle as well as with the Biden administration, according to the announcement.

Shields said many policymakers have found hearing from a different perspective on the topic "refreshing."

"We're not naive in terms of where we are in the conversation. We're looking to scale up and play a meaningful role," he said.