The Senate Finance Committee has taken a significant step towards potential changes in the pharmacy benefit manager (PBM) industry by passing a reform package. The bill, known as the Modernizing and Ensuring PBM Accountability Act, aims to regulate PBMs in the Medicare Part D, Medicare Advance, and Medicaid spaces. If approved, the bill would bring PBMs under the direct regulation of CMS, giving the agency jurisdiction over both the Part D Plan Sponsors and PBMs.

One of the key requirements outlined in the bill is the delinking of PBMs’ compensation from drug prices, transitioning to a “bona fide service fee” framework. The bill also establishes specific criteria for PBM assessments of pharmacy performance, aiming to level the playing field between independent providers and PBM-owned pharmacies.

The next steps for the bill include moving it to the Senate for full consideration and debate. If it passes the Senate vote, it will then need approval from the House of Representatives before being either approved or vetoed by the President.

The passing of this reform package in the Senate Finance Committee indicates significant momentum and support behind the proposed changes. The bill has enjoyed bipartisan support thus far and is likely to clear the entire Senate. In addition, the House has also expressed strong support for action against PBM abuses.

If the bill is ultimately approved, it could lead to significant changes in the PBM and healthcare landscapes, including more affordable and accessible healthcare. The legislation would bring PBMs under direct CMS oversight and create opportunities for pharmacies to shape policy. It may also potentially change reimbursement frameworks, such as moving to a NADAC framework and requiring greater acquisition cost data from providers.

While there is hope for positive changes, there are varying opinions among stakeholders. Some argue that the control exerted by the three major PBMs has been detrimental to Americans, leading to increased costs for employers, taxpayers, and patients. However, others believe that the bill does not go far enough in addressing these issues.

Overall, the progress of the PBM reform package is being closely watched by the healthcare industry, patients, and consumer groups. If approved, it could result in a more competitive pricing structure, increased medication access, and a more transparent system for patients and healthcare providers.

Definitions:
– Pharmacy Benefit Managers (PBMs): Companies that administer prescription drug programs for health plans, negotiate discounts and rebates with drug manufacturers, and process and pay prescription drug claims.
– CMS: Centers for Medicare and Medicaid Services, the federal agency responsible for administering the Medicare and Medicaid programs.

Sources:
– Original article: [source article]

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