The Senate Health, Education, Labor, and Pensions (HELP) Committee has passed bipartisan legislation that improves the transparency of Pharmacy Benefit Managers (PBMs) so patients can know what they’re expected to pay and employers have the ability to shop around for the best deal.
The bills are aimed at speeding generic drug competition and reining in drug middlemen business practices. But they failed to pass an ambitious reform to the pharmacy benefit manager sector, despite strong bipartisan support for it.
Chair Bernie Sanders (I-Vt.) is pursuing the drug pricing reforms at the request of Senate Majority Leader Chuck Schumer (D-N.Y.), who wants to hold a floor vote on an even bigger package of health bills later this year.
It’s not clear when the Senate would take up that package, and while the package is bipartisan, it’s not clear whether it has enough support among House Republicans to pass in that chamber.
In addition, Senator Bob Menendez (D-N.J.), a senior member of the U.S. Senate Finance Committee, and Sen. James Lankford (R-Okla.) have introduced the Ensuring Access to Lower-Cost Medicines for Seniors Act – vitally important bipartisan legislation to tackle one of the biggest drivers of the high cost of prescription drugs, particularly for senior adults on Medicare.
The Ensuring Access to Lower-Cost Medicines for Seniors Act would ensure that patients can finally benefit from lower-cost products instead of being forced to pay for higher-priced drugs solely because of pricing gimmicks used by pharmacy benefit managers (PBMs), the drug pricing middlemen.
This legislation would clearly establish pricing “tiers” to separate lower-cost generic drugs and biosimilar products from name-brand drugs so that patients pay less out of pocket for truly lower-priced drugs, therefore incentivizing prices to drop for patients.
The Ensuring Access to Lower-Cost Medicines for Seniors Act requires:
- Medicare Part D covers a generic or biosimilar if it costs less than its name-brand counterpart.
- Generic drugs or biosimilars to be placed on a generic/biosimilar formulary pricing tier, and name-brand drugs to be placed on a brand tier, with the generic tier having a lower insurance cost-sharing requirement for patients than the name-brand tier.
- A new tier for specialty generics or biosimilars would also have a lower insurance cost-sharing requirement for patients.