Congress Fails to Regulate Pharmacy Benefit Managers Due to Concerns over Public Health Program Funding

In Washington, Congress did not take any action this spring to regulate the operations of pharmacy benefit managers (PBMs), a result that lobbyists in the industry were seeking. However, despite the lack of action by Congress, there were initiatives in Congress that aimed to increase transparency and reform how PBMs function in various sectors. The House passed a package focused on transparency, while Senate committees passed reforms for PBMs in Medicaid, Medicare, and commercial insurance markets.

The Pharmaceutical Care Management Association, the largest trade group for PBMs, significantly increased its lobbying spending by 71% from $2.8 million to $4.8 million in the first three months of the year. Despite their efforts to influence the outcome, legislative bodies faced challenges during negotiations as they attempted to address issues related to PBMs. The position of PBMs as intermediaries between drugmakers and health insurers faced scrutiny and potential reforms that would have changed how they operate.

As a result of these challenges, PBM lobbyists worked hard to maintain the status quo and prevent any significant changes to how PBMs operate. Despite their best efforts, however, Congress failed to take action on these issues due to concerns about government spending bills requiring funding for public health programs. This allowed the industry to continue operating without additional regulations or oversight.

In conclusion, while there were attempts at regulation for pharmacy benefit managers (PBMs) this spring in Washington DC., Congress did not take any significant actions which has allowed the industry continue operating without further regulation or oversight due to concerns about government spending bills requiring funding for public health programs.