How Pending Federal Bills Targeting Pharmacy Benefit Managers Might Help Patients: 'Reform School' for PBMs

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How Pending Federal Bills Targeting Pharmacy Benefit Managers Might Help Patients: 'Reform School' for PBMs
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Dr Madelaine A. Feldman discusses how bills might affect access to medications, delink drug list prices from PBMs' income, and redirect drug manufacturers' price concessions from payers to patients.

Rheumatologist, The Rheumatology Group, New Orleans, Louisiana ; Vice president, Advocacy and Government Affairs, Coalition of State Rheumatology OrganizationsThe term “reform school” is a bit outdated. It used to refer to institutions where young offenders were sent instead of prison. Some argue that pharmacy benefit managers should bypass reform school and go straight to prison.

Quality and Timeliness Standards: The Centers for Medicare & Medicaid Services will set standards for the quality and timeliness of PA determinations. This practice is evident in both commercial and government formularies, where brand-name drugs are often preferred, while lower-priced generics are either excluded or placed on higher tiers. As a result, while major PBMs benefit from these rebates and fees, patients continue to pay their cost share based on the list price of the medication.

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