Federal Update: Senate Introduces Comprehensive PBM Reform Legislation
On Dec. 4, Senators Mike Crapo (R-ID) and Ron Wyden (D-OR), Chair and Ranking Member of the Senate Committee on Finance, introduced the PBM Price Transparency and Accountability Act (S. 3345). The bill’s introduction signifies Congress’ appetite towards passing pharmacy benefit manager (PBM) reform, with many of the bill’s provisions included in earlier reform proposals adopted at the state level. This includes bans on the use of spread pricing arrangements, delinking PBM compensation from the price of a drug, and increased transparency into PBM contracts and business practices.
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A federal district court in Georgia issued a sweeping ruling that could potentially undermine the legal foundation of the Medicare Advantage (MA) Star Ratings program and invite additional challenges to policies established through sub-regulatory guidance. The court found that the Centers for Medicare and Medicaid Services (CMS) improperly relied on measures based on data not collected through the statutorily required measurement systems and failed to meet notice-and-comment requirements for certain measures.
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