The PBM Transparency Act of 2022 would “make it illegal for PBMs to engage in ‘spread pricing’ in which they charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy, and then pocket the difference,” says the fact sheet. “The bill would also prohibit PBMs from arbitrarily, unfairly, or deceptively clawing back payments made to pharmacies…or lowering reimbursements to offset reimbursement changes in federally-funded health plans.”
PBM formulary exclusions are “skyrocketing,”says a new white paper from health policy consulting firm Xcenda. The three largest PBMs’ formulary exclusion lists increased from 850 unique drugs in 2020 to 1,156 unique drugs in 2022— “often excluding medicines for conditions where it is particularly important for patients and physicians to have multiple treatment options, such as oncology and autoimmune disorders.”
BIO applauds the introduction of the bill—telling the co-sponsors in a letter yesterday it “will further bolster the FTC’s authority to address”…“the role PBMs play in the market for medicines and whose interests they serve.”
The context: The Federal Trade Commission (FTC) has been soliciting comments on PBM business practices, which were due yesterday—here’s what BIO said. The pressure is increasing on both the FTC and Congress to take action on PBMs.