Employers, insurers press Trump and Congress to revive PBM bills

A broad coalition of healthcare companies, employers, labor unions and trade associations is calling on the White House and Congress to enact legislation to curb pharmacy benefit managers that failed to make it across the finish line in December.

Blue Shield of California, employers represented by the ERISA Industry Committee, pharmacies represented by the National Association of Chain Drug Stores and the National Community Pharmacists Association, and an umbrella group called America’s Agenda that includes the insurers Elevance Health, Centene and Kaiser Permanente along with unions and drugmakers, made their plea in letters sent to President Donald Trump and congressional leaders Wednesday.

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A package of healthcare bills including measures that targeted transparency, spread pricing and drug rebates fell off a government funding bill at the last minute after Trump objected to other aspects of the bill.

But the ideas behind them remain popular, and these healthcare, business and labor interests want lawmakers to pick up where they left off by including the PBM policies in the next spending package, which Congress must pass by March 14 to prevent a partial shutdown.

"These reforms have received overwhelming bipartisan support both inside the halls of Congress and among the American public and would have an immediate impact on the lives of millions of Americans who have, for too long, been paying more than they should for prescription drugs," the companies and organizations wrote to House Speaker Mike Johnson (R-La.), House Minority Leader Hakeem Jeffries (D-N.Y.), Senate Majority Leader John Thune (R-S.D.) and Senate Minority Leader Chuck Schumer (D-N.Y.).

The leading PBMs are Cigna unit Express Scripts, CVS Health subsidiary CVS Caremark and UnitedHealth Group division OptumRx.

The PBM Accountability Project, made up of unions, pharmacies and consumer groups, and Transparency-Rx, which represents smaller PBMs, also signed the letters. Other members of America's Agenda include the Pharmaceutical Research and Manufacturers of America, Novo Nordisk, the International Brotherhood of Teamsters, the American Federation of Teachers and the United Mine Workers of America.

As the letters note, numerous PBM bills advanced in the Senate and House in the last Congress on a bipartisan basis, but never quite made it into law.

In the dispatch to Trump, the coalition cites his pledge to go after PBMs. "We’re going to reduce prices because the middleman makes more money than the drug companies," he said on NBC News's "Meet the Press" in December.

"Mr. President, this point is spot on. Your leadership is critical as Congress needs to act and save billions in wasteful spending," the letter says. "As you have long recognized, our prescription drug pricing system is badly broken — where middlemen maintain a rigged system that escalates their profits at the expense of hardworking American families, employers and taxpayers."

While legislation targeting PBMs is just starting to reemerge on Capitol Hill, the letters to Congress and the president note the earlier package is an easy model to embrace. "With your leadership Congress can finally move on legislation it already took up in December during your transition," the letter to Trump says.