Pharmacy benefit manager (PBM) reform continues to gain momentum as policymakers pursue measures aimed at increasing transparency, restructuring compensation models, and strengthening pharmacy access protections. A recent American Journal of Managed Care (AJMC) feature highlights five core policy goals shaping the current reform landscape, including pricing transparency, rebate pass-through requirements, delinking PBM compensation from drug costs, enhanced oversight of pharmacy networks, and growing scrutiny of vertical integration across the drug supply chain.
Jesse Dresser, partner in Frier Levitt’s Life Sciences Department, provided insight into one of the most significant developments: the move to prohibit PBMs from earning revenue tied to drug list prices. As reforms shift PBMs toward flat service-fee models, Dresser noted the impact will extend broadly across affiliated entities involved in rebate and aggregation arrangements.
“What the law does now is it says no part of a PBM’s compensation can be derived from anything tied to the cost or the list price of the drug,” Dresser explained, adding that the changes are expected to “radically change how PBMs can derive money in the Medicare Part D space.”
Dresser also pointed to reforms that position CMS to play a more active role in pharmacy network standards and reimbursement disputes, potentially giving independent and community pharmacies clearer pathways to challenge unreasonable contract terms as oversight of PBM practices expands.
Read the full article with AJMC.
