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.

© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

Related Posts

business-meeting
May 23

Plans Take Wait-and-See Approach to Vendors Promising Help with Weight Loss Medication Costs

READ MORE
iv-bag
May 23

Studies: IRA Will Spur Medicare Biosimilar Adoption — and Shift Costs to Part D Plans

READ MORE
rpm
May 23

Remote Physiologic Monitoring Use Among Medicaid Enrollees Skyrocketed From 2019 to 2021

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today