U.S. Rep. Buddy Carter (R-GA) on March 17 proposed bipartisan legislation that aims to save taxpayers billions of dollars by eliminating the use of spread pricing by pharmacy benefit managers (PBMs).
“PBMs have been allowed to rob patients, small businesses, and taxpayers blind for decades. As a pharmacist, I’ve seen firsthand how patients have been forced to stay sick and forgo medication due to the broken process,” Rep. Carter said. “With this bill, we can hold PBMs accountable for their role in increasing the cost of healthcare and pocketing taxpayer money.”
Spread pricing occurs when a PBM charges health plans for prescription drugs more than they pay the pharmacy, according to a bill summary provided by the congressmen, and instead of passing the full payment on to pharmacies, PBMs keep the “spread” as profit while the pharmacies are reimbursed below their costs.
Rep. Carter sponsored the Drug Price Transparency in Medicaid Act of 2023, H.R. 1613, with five original cosponsors, including U.S. Rep. Vicente Gonzalez (D-TX), to end spread pricing in Medicaid programs that oftentimes leads to low reimbursement rates for pharmacies and artificially raises healthcare costs, the summary says.
If enacted, H.R. 1613 also would establish oversight of, and accountability for, PBM tactics that threaten patient access to health care and increase prescription drug spending in Medicaid programs, states the summary.
“Patients should not have to decide between buying life-saving medicine or groceries. Prescription drug prices have become so high that patients are having to make these difficult and dangerous choices,” said Rep. Gonzalez. “I am proud to re-introduce this bipartisan bill with Congressman Carter to put patients first, hold industry accountable, and bring down the price of life-saving medicine.”
H.R. 1613 has been referred for consideration to the U.S. House Energy and Commerce Committee.
“I am proud to have bipartisan support and commitment to protecting the lives, health, and pocketbooks of patients across America,” Rep. Carter said.