House, Senate craft separate health care packages

Senate Majority Leader Charles E. Schumer, D-N.Y., is aiming to put a drug pricing package on the floor this year. While the parameters of the legislation are still fluid, several committees across the Capitol have approved or are on the verge of marking up bills addressing PBMs, the drug pricing middlemen many members blame for high costs and drug access issues.

The proposals all have a similar focus on transparency and are bipartisan, raising the odds that something could pass this Congress. But a potential vehicle and timeline is still unclear as the two chambers have not yet talked to each other, lawmakers say.

“I don’t know that these will all become one single bill, but I think there are a lot of policies we’re going to pursue, and we really hope to see a majority of this or all of it signed into law,” said Rep. Brett Guthrie, R-Ky., who chairs the House Energy and Commerce Health Subcommittee, which on Wednesday debated 17 health proposals, including three related to PBMs.

But lawmakers have not yet decided how to address unfinished business on insulin prices in the commercial insurance market. Democrats capped Medicare copays at $35 a month last year but were blocked from extending the cap to the commercial market under procedural rules.

It’s not clear if insulin legislation will make it into a final package. Senate action on insulin could skip the regular committee process after two bills were excluded from the Health, Education, Labor and Pensions Committee markup on four PBM bills next week.

HELP Chairman Bernie Sanders, I-Vt., would not say whether he supported either bill but said he would expect to see a “merger of a number of bills” on the floor.

Sen. Jeanne Shaheen, D-N.H., who is co-sponsoring one of the insulin bills with Sen. Susan Collins, R-Maine, said she was engaged in talks to bypass regular order.

“I think there’s a question about what is most helpful to move the legislation and how that’s done,” she said. “And that’s an ongoing conversation.”

PBMs

Energy and Commerce on Wednesday discussed a bipartisan bill sponsored by Rep. Earl L. “Buddy” Carter, R-Ga., that would ban “spread pricing” by pharmacy benefit managers in Medicaid, a practice that occurs when a PBM charges a health plan higher prices for drugs than what is paid to the pharmacy. The state of Ohio sued Centene over such a process before reaching a settlement in 2021.

Another bill sponsored by Rep. Ann McLane Kuster, D-N.H., would require PBMs to provide employers with data on drug spending, rebate information and the rationale for formulary placement. That bill is similar to one sponsored by Sanders scheduled for the Senate HELP markup next week. Sanders, however, said he was unaware of the House’s plans.

And a third Energy and Commerce discussion draft bill would create cost-sharing limits on “highly rebated” drugs.

“I think there’s a majority on both sides of the aisle for almost every policy,” Guthrie said, adding the committee hasn’t worked with the Senate yet but hopes that bipartisan action on the House would pressure the Senate to act.

The Pharmaceutical Care Management Association, which represents PBMs, is pushing back against the scrutiny. CEO JC Scott scolded lawmakers and reporters for focusing on “outlier situations” at the group’s annual policy forum Tuesday.

“While we should absolutely focus on ensuring fewer patients fall through the cracks when it comes to affordability and access, we can’t lose sight of the fact that our system is working for so many others,” he said. “Because if we do lose sight of that reality, we run the risk of advancing legislation and regulation that undermines the health care system instead of improving it.”

The Senate HELP package also includes three long-standing bipartisan measures, including one to strengthen oversight of the Food and Drug Administration’s citizen petition process, another to improve incentives for generic manufacturers and a third aimed at boosting competition for rare disease drugs.