Political Pressure Stalls PBM Regulation Reforms in Congress: A Look at the Failed Efforts to Address Industry Issues This Spring

In Washington, Congress did not take any action to regulate the operations of pharmacy benefit managers (PBMs) this spring, despite the efforts of some members to reform the industry. The Pharmaceutical Care Management Association, a trade group representing PBMs, spent $4.8 million on lobbying in the first three months of the year, up from $2.8 million in the previous period.

However, there were initiatives in Congress aimed at increasing transparency and changing 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. Additionally, public health programs received funding in a government spending bill, allowing members of Congress to avoid voting on individual issues.

Despite these efforts by legislative bodies to address issues related to PBMs, Congress ultimately failed to take any significant action on the matter this spring. This left many stakeholders feeling frustrated and concerned about the lack of regulation and oversight within the industry.

The position of PBMs as intermediaries between drugmakers and health insurers faced challenges during negotiations this year. With increasing scrutiny and potential reforms looming over them, PBM lobbyists worked hard to maintain their status quo and prevent any significant changes to how they operate.

Overall, while some progress was made towards addressing issues related to PBMs this year in Congress, ultimately no significant action was taken due to political considerations and pressure from powerful special interests groups within the industry.