Recent federal reforms targeting pharmacy benefit managers (PBMs) introduced new transparency measures and delinked PBM compensation from drug prices in Medicare Part D. However, policymakers and industry stakeholders continue to debate whether additional reforms are necessary to address deeper structural issues. One proposal receiving attention is the Break Up Big Medicine Act, which seeks to prohibit vertically integrated healthcare companies from owning PBMs, insurers, pharmacies, or certain healthcare providers within the same corporate structure. Despite growing concern over consolidation in the healthcare industry, many believe the bill faces significant political and legal hurdles and is unlikely to pass in its current form.
A.J. Barbarito noted in an article with MedCity News that while the legislation may struggle to gain traction as a standalone measure, it still serves an important purpose in advancing the broader policy discussion around consolidation and conflicts of interest in the PBM market.
“I think that it is very important for people to start discussing the problem of consolidation and vertical integration. … It is very obvious that there is a profound conflict of interest with a PBM that contracts with pharmacies setting rates for the pharmacy that it itself owns, and setting rates for its own competitors. It’s viscerally disturbing to see a system that currently permits that. What I really like about this bill is that it brings that to light, and it opens up a conversation for folks.”
Read the full article with MedCity News.
Also published in Dealbreaker.
Senior Associate
