Memphis Standard

U.S. Senators Marsha Blackburn, Maggie Hassan, and Mark Warner have introduced the Patients Before Middlemen (PBM) Act. This legislation aims to separate pharmacy benefit managers' (PBMs) compensation from drug prices and usage. It also seeks to ensure fair treatment of pharmacies by mandating that Medicare Part D plans contract with any willing pharmacy meeting reasonable terms.

Senator Blackburn stated, "The Patients Before Middlemen Act would increase transparency and reduce prescription drug costs for seniors at the pharmacy counter. For too long, middlemen have taken advantage of misaligned incentives in the pharmaceutical supply chain at the expense of taxpayers and seniors. We need to put patients before the profits of pharmacy benefit managers."

Senator Hassan emphasized the importance of this bill for seniors: "Seniors shouldn’t have to choose between paying for essential medications and other basic needs. This bipartisan legislation will help stop pharmacy benefit managers from exploiting loopholes that allow them to drive up drug prices, saving seniors their hard-earned money while also saving taxpayer dollars. I urge my colleagues to support this bill, and I will continue to work to lower prescription drug costs for Granite Staters and all Americans."

Senator Warner added his concerns about PBMs' impact on seniors: "For too long, Seniors on fixed incomes have had to worry about the high cost of prescription drugs. Meanwhile, PBMs continue to contribute to this phenomenon by keeping drug prices high and reimbursements for local pharmacies low. Seniors on Medicare – and the Medicare program itself – can’t afford to be taken advantage of by middlemen who don’t contribute to quality of care. I’m proud to introduce this legislation as part of our ongoing fight to get these policies across the finish line."

The legislation is co-sponsored by Senator James Lankford.

PBMs act as intermediaries managing prescription drug benefits for health plans like Medicare Part D. They decide which medications are covered and determine patient costs but are often incentivized financially based on drug prices, which can lead them towards more expensive options.

The PBM Act proposes several changes:

- Ensuring fair treatment by requiring Part D plans to contract with any willing pharmacy.

- Introducing essential retail pharmacies classification in rural areas.

- Enhancing transparency so PBMs do not limit patient access under Medicare Part D.

- Prohibiting PBM compensation tied directly to drug prices.

- Creating an enforcement mechanism requiring excess fees paid back to the U.S. Department of Health and Human Services Secretary.