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- Pharmacy benefit managers can breathe a sigh of relief after provisions that would have placed additional rules on them that were included in the House version were excluded in the just passed Senate version of the One Big Beautiful Bill.
- The policy would have prevented PBMs, also known as “drug middlemen,” from having their compensation linked to the list prices of medications.
- In June, Bloomberg reported that the policy would have impacted the way PBMs were paid for Medicare. The House version also included a provision that Medicaid managed care plans would ban spread pricing, a practice where a PBM charges a health plan more for a prescription drug than it pays the pharmacy for the same drug, pocketing the difference as profit.
- The major U.S. PBMs are Optum Rx, owned by UnitedHealth (NYSE:UNH), Express Scripts, part of Cigna (NYSE:CI), and CVS Caremark, owned by CVS Health (NYSE:CVS).