Health Care — Lawmakers push for PBM reform

Presented by Children's Hospital Association — The legislation would be the biggest-ever effort to regulate the industry .

View Online Health Care Health Care PRESENTED BY  The Big Story  Lawmakers push health insurers, PBMs to sell pharmacy businesses Pharmacy benefit managers (PBMs) are facing a new round of scrutiny this week across Capitol Hill.  © AP A bipartisan, bicameral effort would force insurers to sell pharmacy businesses, breaking up what lawmakers said was a major conflict of interest in the PBM industry.   At the same time, outside groups including pharmacists, pharmacies, drugmakers and others are pushing hard for lawmakers to include PBM reforms in a year-end spending bill, though it's still unclear if anything beyond a short-term continuing resolution will make it through.    A bipartisan group of lawmakers introduced a bill Wednesday that would force insurance companies that own PBMs to divest their pharmacy businesses. It's likely too late in the year for the bill to advance, but the bipartisan effort shows lawmakers are trying to lay the groundwork for reform next year.    The bill led by Sens. Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.) would prevent a parent company of an insurer or PBM from also owning pharmacies and require those entities to sell pharmacy assets within three years.     If passed, the legislation would represent the most significant effort to regulate the industry ever. It would slash revenue and the power PBMs hold over the market. PBMs are vertically integrated, serving as health plans and pharmacists.      The three biggest PBMs — CVS Health's Caremark, Cigna's Express Scripts and UnitedHealth Group's OptumRx — are owned by insurance companies, which in turn also own specialty, mail order or retail pharmacies.      "The insurance monopolies are ruining American health care. Patients and independent pharmacies are paying the price," Hawley said in a statement.   "This legislation will stop the insurance companies and PBMs from gobbling up even more of American health care and charging American families more and more for less."  Welcome to The Hill's Health Care newsletter, we're Nathaniel Weixel and Alejandra O'Connell-Domenech — every week we follow the latest moves on how Washington impacts your health. Did someone forward you this newsletter? Subscribe here. Essential Reads  How policy will be impacting the health care sector this week and beyond: House Republicans launch investigation into CVS Caremark for potential antitrust violations House Republicans want to know whether pharmacy benefit manager (PBM) CVS Caremark violated federal antitrust laws by threatening independent pharmacies to keep them from using money-saving tools outside the PBM's network.  In a letter to CVS obtained by The Hill, House Judiciary Committee Chair Jim Jordan (R-Ohio) asked the company for documents and communications about pharmaceutical hubs, a type of digital pharmacy …  Full Story Ocasio-Cortez: People experience denied claims as 'act of violence' Rep. Alexandria Ocasio-Cortez (D-N.Y.) said denied claims from a health insurance company could be interpreted by people struggling to afford health-related costs as “an act of violence” against them. “All of that pain that people have experienced is being concentrated on this event. It’s really important that we take a step back, this is not to comment and this is not to say that an act of violence …  Full Story Ohio Senate passes measure forcing hospitals to administer ivermectin, other patient-requested treatments The Ohio state Senate passed a bill earlier this week that will allow patients to force hospitals to administer drugs for off-label use.   The passage of the bill comes after a years-long effort by Republican lawmakers in the state to expand COVID-19 patients’ access to drugs like ivermectin and hydroxychloroquine, according to reporting from the Ohio Capital Journal.  Multiple high-profile conservatives — including President-elect …  Full Story In Other News  Branch out with a different read from The Hill: Montana Supreme Court upholds lower court ruling that allows gender-affirming care for minors HELENA, Mont. (AP) — A Montana law banning gender-affirming medical care for transgender minors will remain temporarily blocked, the state Supreme Court ruled Wednesday, after justices unanimously agreed with a lower court judge who found the law likely violates the state’s constitutional right to privacy. The case against the Montana … Full Story A MESSAGE FROM CHILDREN'S HOSPITAL ASSOCIATION Children's hospitals make more moments possible.  First smiles, first steps, first words, first dances. Children's hospitals provide advanced, specialized care to children and teens, making every remarkable milestone and precious moment possible. Learn more. Around the Nation  Local and state headlines on health care: UCLA student sues California doctors, says she was 'fast-tracked' into transgender surgery (NBC)  New York law mandates health insurers cover EpiPens; out of pocket costs will be limited (Staten Island Advance)  State agency asks lawmakers for $300 million to fix 'significant neglect' in Texas' Medicaid enrollment system (The Texas Tribune)  What We're Reading  Health news we've flagged from other outlets: Gilead to test once-a-year HIV prevention shot (STAT)  Killing of health insurance CEO draws attention to frustration over denied claims (NBC)  Patients couldn't pay their health bills. Hospitals turned to solar power for help (KFF Health News)  What Others are Reading  Most read stories on The Hill right now: Schumer says Senate will vote on Social Security changes  Senate Majority Leader Chuck Schumer (D-N.Y.) said Wednesday he's "doing everything" he can to try to pass legislation that would enact some Social … Read more The pitchforks are here: Populist rage and the rise of moral absolutism In 2014, billionaire Nick Hanauer warned in Politico that “The Pitchforks Are Coming … For Us Plutocrats.” He argued that extreme … Read more What People Think  Opinion related to health submitted to The Hill: America's system to fund and reimburse health care is broken   You're all caught up. See you tomorrow!  Check out The Hill's Health Care page for the latest coverage. Like this newsletter? 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