Senators Tom Carper of Delaware and Chuck Grassley of Iowa have introduced a new bill, the PBM Oversight Act of 2023, aimed at granting the Centers for Medicare and Medicaid Services (CMS) greater authority in regulating pharmacy benefit managers (PBMs) and their influence on drug pricing. PBMs act as intermediaries within the pharmaceutical industry, negotiating discounts with drug manufacturers and determining which drugs will be covered by health insurance companies. The bill would require PBMs to provide detailed information to CMS annually, including documentation of their interactions with recommendation committees that decide which drugs will be included in a formulary. The bill also calls for transparency in the decision-making process, mandating that PBMs disclose their drug selection and justification for those decisions. The Government Accountability Office would be responsible for studying this information and reporting its findings to Congress. Both senators believe that this bill will hold PBMs accountable and prioritize the needs of patients over PBM profits. Several other bills are currently under consideration in Congress to address PBM reform as part of the larger effort to lower drug prices in the United States. The increased scrutiny of PBMs has led to intense lobbying by both the healthcare and PBM industries. Senator Grassley has previously introduced the Pharmacy Benefit Manager Transparency Act, which would task the Federal Trade Commission with examining PBM business practices. He has also called on fellow Republicans to support PBM reform and pass legislation to ensure transparency and accountability in the industry.
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