WASHINGTON, D.C. – This week, the House of Representatives passed H.R. 5378, the Lower Costs, More Transparency Act. This legislation, passed by an overwhelming bi-partisan majority, contained a provision from Chairman Arrington’s Better Deals and Lower Prices Act (H.R. 4846). Arrington’s provision was designed to arm employers with the information they need to make informed contracting decisions with PBMs and will lower the premiums of working-class families across the country.
“While America leads in medical innovation and ingenuity, our health care delivery system has fundamental flaws that disadvantage patients and taxpayers alike. By increasing transparency on prescription drug prices, we empower consumers to make informed decisions, inject much-needed competition into the health care market; and ensure taxpayer dollars are being spent in the most cost-effective manner,” said Rep. Arrington. “I’m proud to introduce the Better Deals and Lower Prices Act to arm job creators with the information they need to get the best deal possible and lower prices for their employees, while driving down premiums, and reducing health care costs across the board.”
Background:
Many companies do not have the resources to negotiate back and forth with drug manufacturers on the cost and quantity of the drugs they require for their employees.
Traditionally, PBMs filled this function, and while companies don't have to contract with a PBM to develop their drug benefit, virtually all of them do.
Over time, and due largely to a lack of oversight and transparency, the 3 Largest PBMs have grown to control 90% of the market - while patients and employers face mounting barriers to understanding how PBMs negotiate for them, and whether the deal they're getting is as good as they think.
This means two things:
Companies can't act as rational consumers and compare PBM net price data across the market, or "shop around," and
Working Americans with employer sponsored insurance (roughly 160,000,000 of them) are paying higher premiums than they need to.
The Better Deals and Lower Prices Act will address this by requiring PBMs to share net price data from all drugs regardless of class to employers that request it, allowing businesses small and large to access the same information and shop effectively.
