A bipartisan group of lawmakers introduced legislation to break up pharmacy-benefit managers, the drug middlemen that have now faced yearslong scrutiny from Congress and the Federal Trade Commission.
A Senate bill, sponsored by Sens. Elizabeth Warren (D., Mass.) and Josh Hawley (R., Mo.), would force companies that own health insurers or pharmacy-benefit managers to divest their pharmacy businesses within three years.
A companion bill, which sponsors say draws on a history of government prohibitions on joint ownership within industries, was also introduced in the House on Wednesday.
If passed, the legislation would be the most far-reaching intervention yet into the operations of pharmacy-benefit managers, known as PBMs, and their parent companies, cutting off a major source of revenue for the companies and frustration for patients.
Originally conceived as a means to reduce medication costs for patients, PBMs have grown to monopolize the prescription drug market. It is utilized by the giants of the healthcare industry.
The three biggest PBMs—CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealthGroup’s OptumRx—belong to companies that own some of the country’s largest health insurers. They distribute some medicines through their own mail-order pharmacies. CVS also owns more than 9,000 retail pharmacy locations.
“PBMs have manipulated the market to enrich themselves—hiking up drug costs, cheating employers, and driving small pharmacies out of business,” Warren said. “My new bipartisan bill will untangle these conflicts of interest by reining in these middlemen.”
Hawley said the legislation “will stop the insurance companies and PBMs from gobbling up even more of American healthcare and charging American families more and more for less.”
“Any policies that would limit our ability to negotiate with drugmakers and pharmacies would ultimately increase the cost of medicine in the United States, and in many cases, serve as a handout to the pharmaceutical industry,” said a CVS Health spokesman.
PBMs are powerful players in the prescription drug business, influencing which medicines insurance plans will pay for and how much.
The assassination of United Health Care CEO Brian Thompson brought to the forefront the inequity of the health system.
Lawmakers Plot to Force Health Insurers to Sell Off Pharmacies - WSJ
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