Congress has scant time to send President Donald Trump a spending bill to fund federal operations for the remainder of fiscal 2025 or it risks triggering a partial government shutdown March 14. Republicans also are swiftly moving forward with a massive tax cuts and spending reductions measure. Either could be a vehicle for the PBM legislation. And like any other bill, House GOP leaders could put it directly on the floor for a vote, which likely would be successful.
Republican and Democratic senators likewise intend to try again on PBMs. A wide swath of the healthcare sector, including providers, health insurers and employers that sponsor workplace health plans, is lobbying Congress to speed ahead.
The PBM industry has fought tooth and nail against the legislation, saying it will harm their ability to strike deals with drugmakers, leading to higher costs.
“Pharmacy benefit managers share the goal of policymakers on both sides of the aisle, of lowering prescription drug costs for patients. That is why PBMs are already rapidly adapting and innovating in the private market to address health plan sponsor demand for more choices, greater transparency and options that lower out-of-pocket costs for patients," the Pharmaceutical Care Management Association, which represents PBMs, said in a statement. "While Big Pharma pushes a self-serving agenda designed to keep prices high by undermining the critical cost-saving role of PBMs, our members are meeting concerns in the market right now.”
After the hearing, Carter said PBM measures likely wouldn't be included in the government funding bill needed by March 14.
The sweeping tax and spending cuts measure, which the White House and congressional GOP leaders are assembling without Democrats, could be a fit. But under the special "budget reconciliation" rules Republicans are using to prevent Senate Democrats from blocking the bill with filibusters, it can only modify tax revenues and federal spending. Although provisions governing PBMs under Medicare, for example, meet that standard, others may not, such as rules related to employer-sponsored health plans.
Rep. Diana DeGette (D-Colo.), the Health Subcommittee's ranking member, suggested taking PBM legislation — and extensions of expiring health programs — directly to the floor via what's known as the suspension calendar. That expedited process limits debate and precludes amendments but requires a two-thirds majority for passage.
"I'm going to guarantee you every Democrat would vote for that," DeGette said, urging that bill move before the fiscal 2025 spending package.
Guthrie and Carter expressed willingness to pursue a suspension bill or another alternative to attaching PBM provisions to a broader measure.
"To be able to move these outside of reconciliation means we're going to have to work together. We have to do it in a bipartisan way. Hopefully we're going to find that pathway," Guthrie said.
Legislation that nearly made its way to President Joe Biden two months ago contained a variety of new rules to govern PBMs.
The measure would have demanded increased transparency into the prices PBMs negotiate for government health programs, insurance companies, employers and other health plan sponsors. It also would have banned or limited revenue-generating practices such as spread pricing, which is when a PBM charges its clients a higher amount for a medication than it negotiated with the drugmaker and keeps the difference. The legislation would have required PBMs to pass along all the discounts they extract from pharmaceutical companies.
Congress was set to pass a stopgap fiscal 2025 spending bill that incorporated the PBM language until then-President-elect Trump and his billionaire deputy Elon Musk derailed the effort with objections to unrelated elements of the legislation. House Speaker Mike Johnson (R-La.) responded by excising the PBM provisions and many other parts from the bill, which Biden later signed.
DeGette chastised Republicans for giving in to Musk two months ago, and called for the healthcare measures to be brought back before government funding runs out March 14.
"Here we are again, all because some of my colleagues don't want to stand up for all Americans," DeGette said. "Nevertheless, I look forward to working with this committee ahead of the March deadline to see those already negotiated reforms to the finish line."
