Bipartisan bills in Congress would force insurance companies, PBMs to sell pharmacies
A bipartisan group of lawmakers has introduced bills into both the U.S. House of Representatives and the Senate that would force insurance companies and pharmacy benefit managers (PBMs) to divest in any pharmacies they own. The bills were introduced on Dec. 11.
Together, the bills mirror each other as the Patients Before Monopolies Act, sponsored in the House by Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN), and Elizabeth Warren, (D-MA) and Josh Hawley (R-MO).
In a statement, the group said the Patients Before Monopolies Act would rein in PBMs by prohibiting their parent companies from owning any pharmacy business, including services conducted by mail. Any company that currently owns both a PBM and a pharmacy would have three years to offload their pharmacy business to a new company.
The proposed law would also enable the Federal Trade Commission (FTC), the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) to seize revenue generated by companies in violation of the law.
All divestitures are to be reported to the FTC, per the terms of the bills.
“As a lifelong pharmacist, I know firsthand how unchecked PBM consolidation and vertical integration have allowed these shadowy middlemen to self-deal and manipulate the system in ways that are driving up drug costs, limiting patient choices, and putting the financial screws to independent community pharmacies,” Representative Harshbarger said in the statement.
“Federal regulators should never have let this excessive concentration of our healthcare industry happen in the first place, and so it’s up to Congress to get the job done,” she added.
The act follows recent lawsuits against UnitedHealth Group, Cigna and CVS, which operate the nation’s three largest PBMs. The FTC is currently suing the three companies for designing “a system in which drug manufacturers compete for formulary placement by raising—not lowering—drug list prices.” In its claim, the FTC accuses the “big three” of controlling the price of insulin through a pharmacy rebate scheme, the cost of which is passed onto patients.
In Texas, state Attorney General Ken Paxton has filed a similar lawsuit, also targeted at the same three companies, for “artificially and willingly” raising the price of insulin.
Several policy groups have expressed support for the Patients Before Monopolies Act, including the American Economic Liberties Project and the National Community Pharmacists Association.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.