Q&A: PBM Legislation “Highly Likely” to Pass This Year

It is “highly likely” that pharmacy benefit management (PBM) legislation will cross the legislative finish line this year, according to Patrick Cooney, president of The Federal Group, a Washington, DC-based lobbying firm. Cooney was interviewed during the 2024 Pharmacy Benefit Management Institute Annual National Conference by Drug Topics’ sister publication, Managed Healthcare Executive, where he discussed the role of the Federal Trade Commission (FTC) interim report in galvanizing legislators, as well as his predictions on what provisions the potential PBM legislation might contain.

Q&A: PBM Legislation “Highly Likely” to Pass This Year / Bill Perry - stock.adobe.com

What are the chances that Congress will pass PBM legislation this year?

Patrick Cooney: I think the prospects are high. After the PBMI conference, I head back to Washington, DC. We have about a 3-week period where Congress is going to try to get a lot of different things done, [including] a number of health policy matters.

I do think PBM legislation is on the table, but I think it's unlikely something's going to happen [in] the next 3 weeks. I think more likely this is going to be legislation in a lame duck session of Congress. Postelection, Congress will come back before the new Congress sits on January 1 to finish up some of the difficult legislation; by difficult, I mean some of the things that they have to spend a lot of money on.

The PBM legislation that we've seen in the House and the Senate saves some money under Medicare, so that savings is going to be used to bolster other areas of Medicare. That's why I think it's highly likely that PBM legislation will get across the finish line.

The other reason is that in July, we saw the FTC came out with [an interim report on its investigation into PBM practices], which highlighted some of the concerns [the agency] had with the PBM community today. I think that's galvanizing action as well.

Senator [Ron] Wyden (D-Oregon), the Senate Finance Committee chair, spoke very vehemently after the report came out and said he was fully committed to getting something done quickly.

If Congress does pass PBM legislation, what will be included?

Cooney: The 3 things we can likely guarantee—because they've been pretty universal throughout the legislation that we've seen, and there's been a lot of legislation in the House and Senate—is the elimination of spread pricing under Medicaid, pass-through of all rebates 100%, and some type of robust reporting requirements. Transparency is the name of the game in DC this year with this Congress [and] not just [for] PBMs; the focus is definitely on hospitals, it is definitely on insurers, [and] I think some reporting requirements to create greater transparency. Those 3 elements I think will be in anything that we see at the end of the year.

READ MORE: Discussing the Lack of Transparency in GPOs of 'Big 3' PBMs

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