Senate Will Likely Decide Fate of Drug Pricing, PBM Reforms

Even as Congress inches closer to passing the largest individual spending bill in U.S. history through budget reconciliation, health care insiders are still uncertain what drug pricing measures could make their way through both chambers. However, D.C. insiders say that some combination of Medicare Part D out-of-pocket spending caps, Medicare drug price negotiation, caps on launch prices and/or price growth, and PBM reform are all possible — though policies will have to make their way through the twin gauntlets of the preferences of Senate committees and the rules requirements of budget reconciliation.

Consideration of drug pricing measures has moved to the Senate. Insiders expect H.R. 3, the law introduced by Speaker Nancy Pelosi (D-Calif.), has the votes to make it out of the lower chamber. However, few expect that the bill would make it through the Senate intact. H.R. 3, titled the Lower Drug Costs Now Act, caps Part D out-of-pocket costs, allows Medicare to negotiate drug prices and bans the price of drugs from increasing faster than the annual rate of inflation. Some — but not all — of those provisions could clear the Senate.

“That’s the thing with reconciliation. It all comes down to having these different rules lined up perfectly with each other,” Ann Marie Breheny, senior legislative adviser for Willis Towers Watson, tells AIS Health, a division of MMIT.

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• Radar on Drug Benefits