House set to vote this week on historic health care package to boost transparency and beat back PBMs

NCPA December 7, 2023

This week, the House is scheduled to vote on H.R. 5378, the Lower Costs, More Transparency Act, a health care package that includes several provisions vital to lowering prescription drug costs and bringing transparency to anticompetitive practices of pharmacy benefit managers. One of those provisions is NCPA priority legislation, H.R. 1613, the Drug Price Transparency in Medicaid Act, introduced by Reps. Buddy Carter (R-Ga.) and Vicente Gonzalez (D-Texas). It reforms Medicaid managed care pharmacy payments by prohibiting the use of spread pricing in Medicaid managed care programs and by requiring reimbursements based on average acquisition costs plus the state’s Medicaid fee-for-service dispensing fee. It requires all pharmacies to respond to the Centers for Medicare & Medicaid Services’ National Average Drug Acquisition Costs survey, which would provide more transparency on drug pricing. Additionally, on Wednesday the Energy and Commerce Committee passed H.R. 2880, the Protecting Patients Against PBM Abuses Act, unanimously. While NCPA has concerns about changes made to the pharmacy provisions of the bill during the mark-up, Chair Cathy McMorris Rogers (R-Wash.) pledged that she and the committee will continue working with sponsors Reps. Buddy Carter (R-Ga.) and Lisa Blunt Rochester (D-Del.) to find ways to move forward to fix the disparities between vertically integrated PBM-affiliated pharmacies and independent pharmacies. The committee also unanimously passed legislation from Rep. Morgan Griffith (R-Va.), H.R. 5393, to ensure fair assessment of pharmacy performance and quality by PBMs in relation to DIR fees in Medicare Part D.