Senators introduced bills to reform PBMs and create new FTC probe

February 2023
U.S. Senator Cantwell (D-Wash) recently re-introduced the Pharmacy Benefit Manager Transparency Act of 2022 which was previously co-sponsored by herself and Senator Grassley (R-Iowa). The bill is intended to bring reforms to the PBM industry by increasing transparency and prohibiting pharmacy payment clawbacks.

The bill is intended to bring transparency to the industry, and to stop practices such as clawbacks that make it difficult to determine what the PBM actually paid a pharmacy for a particular drug.

The bill also requires PBM’s to report their pricing practices to the Federal Trade Commission on an annual basis.

The act also requires the FTC to review any consolidation within the PBM industry. Currently, 3 PBM’s (Caremark, Express Scripts, and OptumRx) serve the vast majority of plan sponsors in the United States. The FTC will be responsible for examining any potentially abusive practices by PBM’s.

Congress has not been successful in bringing transparency to the PBM industry in the past. The pharmaceutical lobby remains one of the most powerful in Washington DC, and so it remains to be seen whether or not this Act will achieve the desired intent.

It is important to know that Crystal Clear Rx is constantly looking for ways to save money where appropriate and to bring our clients the most value for the Rx benefit possible.

Amgen’s Humira biosimilar Amjevita hits the market with two different list prices

February 2023
The version that is priced at 55% would seem to be the best option, however the product offering only a 5% discount includes rebates, and therefore may become the preferred option for many PBM’s. This practice is not new and has been recently used by pharma companies offering insulin biosimilars.

While there may be instances where it makes sense to encourage the use of drugs that provide rebates over those that do not, there are risks involved with rebates. In most cases it takes 9-12 months to recover the rebate on most drugs, so there is a “cost of money” factor involved. But there are other risks as well that must be considered.

Please reach out to your CCRx consultant to discuss any questions you may have.

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