Advocates for tougher restrictions on pharmacy benefit managers are not giving up after Congress reportedly shelved several proposals this week, even if lawmakers see no immediate path forward.
PBM legislation has broad bipartisan support on Capitol Hill. Negotiations appear to have broken down, however, regarding which specific measures to include in the full-year government funding bills that must pass by March 1 and March 8.
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Committees in both the House and Senate have passed a string of bipartisan bills over the past year, most of which would have increased transparency in pharmacy benefit management services. Several would have restricted how PBMs pay themselves.
With high prescription drug prices still a potent political issue, even some lawmakers said they were surprised by the failure to add any of the measures to a package of health bills to move along with the bigger budget bill.
"I'm kind of slack-jawed by it because we got a 26-to-zero vote in the Senate Finance Committee, and you can't get a 26-to-nothing vote to order a 7-Up at this point," said Senate Finance Committee Chair Ron Wyden (D-Ore.), referring to measures his committee passed that would have restricted PBMs alongside enacting several Medicaid and Medicare payment policies. "I've specialized in healthcare a long time and I've not seen anything quite like that."
Asked if any of the PBM measures could be salvaged at some point, Wyden only answered, "We're trying."
Similarly, the Senate Health, Education, Labor and Pensions Committee chaired by Sen. Bernie Sanders (I-Vt.) passed a more aggressive PBM bill targeted to the broader market.
Sanders suggested the matter was now out of his hands.
"You'll have to ask other people about that. I would like it to survive," Sanders said.
Numerous sources off and on Capitol Hill said several disagreements about bill specifics couldn't be resolved along with a budget deal.
Sen. Dr. Bill Cassidy (R-La.), the top Republican on the HELP Committee, declined to discuss specifics of policy disagreements.
Asked if PBMs were dead, Cassidy said, "I don't know," before joking, "They're apparently alive and kicking. Their market valuations are incredible."
He also did not see a clear path forward, but said bills could be revived at some point.
"I sure hope so," Cassidy said. "We've got to address it, and I'm open to finding a way to address it. I'm just so open. And I've been pushing and trying to come up with alternatives."
Members of a new industry group, Transparency-Rx, composed of smaller PBMs who espouse more open operations, said they were at least heartened that PBM bills made it as far as they have. They predicted Congress eventually will act.
"I think the lack of PBM language at this point in the budget package to me has to do with the broader contours about the budget negotiations and the dynamics between the two chambers not really relevant to the substantive support," said Transparency-Rx Managing Director Joe Shields in a briefing with reporters. "There's more work to do. I don't think we're anxious about that, or we're intimidated by it. I think we'll continue to educate and have dialogues are folks. And we're being optimistic that Congress has to act because the affordability crisis isn't getting any better. It's getting worse."
Jake Frenz, the CEO of Smith Rx and a founding member of the Transparency-Rx coalition, said momentum was on the side of groups like his, even if many of the particulars in the PBM market are often complicated and Congress is stuck in a particularly tricky moment.
"I think to get it right here is the most important aspect, and if it takes another couple of quarters to do that, or years even, I'm fine with that," Frenz said. "It doesn't take away the incredible problem of high-cost drugs in the United States and the role that PBMs play."
The Pharmaceutical Care Management Association, a PBM trade group, has pushed back on characterizations that legislation to restrict PBMs would reduce drug costs, saying they would actually benefit drug companies.
