Carter introduces bill to crack down on abuse by pharmacy benefit managers

To help ensure patients receive drugs at the lowest prices, U.S. Rep. Buddy Carter (R-GA) introduced a bipartisan bill that would crack down on pharmacy benefit managers (PBM) by delinking their compensation from the cost of medications.

“PBMs prey on patients and independent pharmacies, driving up costs without providing any real value to patients and our health care system,” Rep. Carter said on May 8.

The Protecting Patients Against PBM Abuses Act, H.R. 2880, which Rep. Carter introduced on April 26 along with lead original cosponsor U.S. Rep. Lisa Blunt Rochester (D-DE), would establish certain requirements for PBMs under Part D of the Medicare program.

To ensure PBMs do not have an incentive to steer enrollees toward high-cost drugs, the bill requires the Part D sponsor to ensure that the PBM derives no income for Part D services other than through flat dollar service fees, and those fees cannot be contingent upon drug prices, discounts, or rebates with respect to covered Part D drugs, according to a legislative summary.

“This strong legislation will shield the millions of victims from PBM abuse and predatory pricing techniques that take advantage of patients and bleed pharmacies dry,” Rep. Carter said.

Specifically, the bill would ban a PBM from compensating a network pharmacy less than affiliated pharmacies; prohibit a PBM from charging the sponsor a different amount for the drug’s ingredient cost or dispensing fee than the amount the PBM reimburses the pharmacy for such ingredient cost or dispensing fee; increase transparency on data related to PBM rebates and administrative fees; and address PBMs’ conflict of interest to a Part D plan’s pharmacy and therapeutics committee, according to a bill summary provided by the congressman’s office.

“Many factors contribute to high health care costs, and one of the most insidious are the opaque practices of Pharmacy Benefit Managers or PBMs,” said Rep. Blunt Rochester. “That’s why I’m proud to join Rep. Carter in introducing the Protecting Patients Against PBM Abuses Act to realign incentives and ensure that PBMs aren’t raising prices on consumers to rake in record profits and increasing transparency so that patients, plans, and other stakeholders can make informed decisions about their health care.”

H.R. 2880 will be considered by the House Energy and Commerce Committee and the House Ways and Means Committee.