STAT+: Congress’s PBM reforms won’t end America’s drug pricing woes. Here’s what they would do
Congress is focused on reining in PBMs to make the system fairer — but none of their many proposals will actually tackle the core dynamic that has incentivized higher drug…
WASHINGTON — Lawmakers in Congress generally agree that there’s something very broken with the way America pays for prescription drugs. They’re focused this summer on reining in pharmacy middlemen to make the system fairer — but none of their many proposals will actually tackle the core dynamic that has incentivized higher drug prices.
There are major packages on so-called PBM reform percolating in at least six different congressional committees. Most have bipartisan support, and there seems to be genuine momentum to do something. Pharmacy benefit managers are companies employed by insurers to negotiate lower drug costs with pharmaceutical companies.
But at best, experts told STAT, the bills work around the fringes. They would offer some more transparency into how the system works, ensure pharmacy middlemen aren’t skimming off of money they send to insurers, prohibit middlemen from overcharging insurers, and ensure certain fees in the Medicare program aren’t tied to drug’s prices.
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