PBM reform - final leg vote Monday

Type 1 & LADA
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LEGISLATURE

It’s the bill known as the Consolidated Appropriations Act, 2026 (H.R. 7148). https://www.jdsupra.com/legalnews/house-passes-hr-7148-advancing-new-pbm-4262549/ Here’s a link to the bill text… https://www.congress.gov/bill/119th-congress/house-bill/7148 looks like it’s Buddy Carter’s bill. That’s great. MSN Shout out to the pharmacists!!! Great work, you guys. https://www.youtube.com/watch?v=3lsPNR-boqM

Summary of bill status: Passed the House, Passed the Senate (but they made some changes). Because the Senate added some language, it needs to return to the House for a final vote on Monday.

DEPT OF LABOR

via Keith SonderlingKeith Sonderling • 2ndVerified • 2ndUnited States Deputy Secretary of Labor
The U.S. Department of Labor issued a landmark proposed regulation designed to bring overdue transparency to the fees and compensation 𝘗𝘩𝘢𝘳𝘮𝘢𝘤𝘺 𝘉𝘦𝘯𝘦𝘧𝘪𝘵 𝘔𝘢𝘯𝘢𝘨𝘦𝘳𝘴 (𝘗𝘉𝘔) receive. The proposed regulation is the most significant federal reform of prescription drug middlemen proposed in decades.

The proposed rule would require pharmacy benefit managers to make disclosures to plan fiduciaries that would allow them to assess the reasonableness of compensation for the services under the law.

The proposed rule requires PBMs to disclose the following information for the first time:

•Rebates and other payments from drug manufacturers.

•Compensation received when the price paid by the plan for a prescription drug exceeds the amount reimbursed to the pharmacy.

•Payments recouped from pharmacies in connection with prescription drugs dispensed to the plan.

The proposed regulation would also allow plan fiduciaries to audit the accuracy of PBM disclosures and provides additional relief for plan fiduciaries if their PBM fails to meet its obligation.

By lowering drug costs, the Trump administration is putting money back in the pockets of American workers and retirees, their families, and businesses.

𝗖𝗼𝗺𝗺𝗲𝗻𝘁𝘀 𝗼𝗻 𝘁𝗵𝗲 𝗽𝗿𝗼𝗽𝗼𝘀𝗮𝗹 𝗮𝗿𝗲 𝗱𝘂𝗲 𝟲𝟬 𝗱𝗮𝘆𝘀 𝗳𝗿𝗼𝗺 𝗶𝘁𝘀 𝗝𝗮𝗻. 𝟯𝟬 𝗽𝘂𝗯𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗶𝗻 𝘁𝗵𝗲 𝗙𝗲𝗱𝗲𝗿𝗮𝗹 𝗥𝗲𝗴𝗶𝘀𝘁𝗲𝗿: LinkedIn

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FTC

We are still waiting for this…summer at the latest, I promise.

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We also have DOJ, Executive Orders, and a variety of State cases & legislation hanging over their heads. It’s a bad time to be a PBM for many reasons. Of course, there are the private lawsuits and free market strategies to cut them out completely (O’Reily’s lawsuit, CA has setup its own drug manufacturing plant with plans to supply the country, Cuban’s work, etc.).

Checkmate.

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Remember that this is a vote on an appropriations bill; the PBM stuff is an add-on. To be dramatic, vote to cut PBMs vote for ICE. I think that’s a way it is done, right? See my more detailed comments on TuD.

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Don’t even say stuff like that Bowler. I’m at the end of my rope trying to figure out what is happening. :sweat_smile:

My interpretation of the new drug pricing situation is this:

There is no real definition of wrongdoing or behavioral constraints introduced by Buddy’s legislation, only transparency. Now, lets assume you get complete and accurate info out of the PBMs (which has been very problematic in the past). You notice an abnormally high expenditure for a drug, either as a patient or as a benefit manager for a large employer plan that is managed by the federal government (that’s 30% of plans in the state of Minnesota), what do you do? You contact your plan sponsor and there is some fiduciary responsibility on their part to manage that. You can sue them if they act irresponsibly, but they should be motivated (given data access) to control plan costs.

What about the other 70% of plans where you can get oversight by the state legislation? We see wide variability in drug pricing state to state.

Insulin is gonna be the example through which the government defines illegal market activity - “price fixing,” “price gouging,” etc. That example is made via the Federal Trade Commission. The FTC hasn’t disclosed how they plan to define that yet…but soon. Once we have that, it offers constraints on future behavior for all drugs in the market (prob applicable to cancer drugs). It facilitates state lawsuits over previous conduct and sets precedent that PhRMA and the insurers can’t just waltz in and sue the states every time they try to regulate or legislate illegal market activity (because FTC will provide a strict definition of what illegal means in that context). Although there are no monetary damages available thru the FTC case, there will be damages possible thru State lawsuits over previous behavior and future behavior.

This is how it will work? That might work.