Like Pharma Executives Before Them, Pharmacy Benefit Managers Escape Largely Unscathed From High-Profile Hearing

Stat: PBMs Sidestep The Senate’s Tough Questions — But Lawmakers Hint At Legislation
The much-maligned pharmacy middlemen escaped largely unscathed during a high-profile congressional hearing Tuesday — but the powerful bipartisan duo behind the hearing now appears intent on legislating, and it looks like increasing transparency will be their primary goal. Executives for the country’s five largest pharmacy benefit managers, the middlemen that negotiate with drug makers over the price of their drugs, were expected to face hard questions about their role in the ever rising price of prescription drugs from members of the Senate Finance Committee. But the PBM executives largely parried the senators’ questions, none of which shone too harsh a spotlight on the industry’s practices. (Forko, 4/9)

The Associated Press: Heated Debate Over High Drug Costs Returns To Capitol Hill
Critics see PBMs as middlemen who add costs to an already expensive system for prescription drugs. Drugmakers point to the rebates as part of the problem. They say they have to offer them to land some of their products on a PBM’s list of covered drugs or a less-expensive tier, and this contributes to higher list prices. High list prices hurt patients who have to pay a big deductible when they fill a prescription. (Murphy, 4/9)

The Hill: Senators Press Drug Industry 'Middlemen' Over High Prices
During a hearing Tuesday, members of the Senate Finance Committee sought to shine a light on the work of PBMs, the drug middlemen, who handle claims for big insurers and help negotiate drug prices with manufacturers. Drug companies have long painted PBMs and insurers as the villains in the pricing debate, and the industry has few backers. “More transparency is needed,” said committee Chairman Chuck Grassley (R-Iowa), who has long criticized PBMs for what what he says are secretive industry pricing practices. "The current system is so opaque that it’s easy to see why there are many questions about PBMs’ motives and practices." (Weixel, 4/9)

CQ: Drug Middlemen Under Scrutiny As Two Panels Take On Prices
Some of the larger benefit managers recently committed to policies meant to appease customers and lawmakers. Insurer Cigna and its PBM-arm Express Scripts recently announced they would cap patient cost-sharing for insulin at $25 a month, and Optum Rx, the PBM-arm of insurance giant UnitedHealth Group, is requiring its employer plans to pass along all negotiated discounts to customers at the point of sale starting in 2020. But the systems give lawmakers and the administration the impression that the PBMs favor higher-cost drugs over cheaper ones. Oregon’s Ron Wyden, the Finance Committee ranking Democrat, described a case in which CVS’ pharmacy benefits arm makes doctors and patients get an authorization before prescribing a lower-cost, unbranded but identical version of a cholesterol drug. The same manufacturer makes both the low-cost and brand-name versions. (Siddons, 4/9)

Modern Healthcare: Senate Panel Favors Lighter Touch For PBM Regulation
Finance Committee Chair Chuck Grassley (R-Iowa) defended the PBMs' role in negotiating prices as set forward in the Medicare Part D program that he helped create. "This system of private entities negotiating is what I envisioned as an author of the Part D program," Grassley said. "I still believe this is absolutely the right approach. I oppose any effort to undo the 'non-interference clause' currently in statute." (Luthi, 4/9)

Kaiser Health News: Senate Hearing On Drug Pricing A Lesson In What PBMs Do
It was back-to-school day at the Senate Finance Committee hearing Tuesday morning. In the third of a series of hearings on rising drug prices, the senators seemed focused on getting an answer to one central question: What the heck is a pharmacy benefit manager? Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them. (Bluth, 4/9)

Bloomberg: Senators Call For Probe Of ‘Spread Pricing’ By Drug Middlemen 
Two U.S. senators have asked the inspector general of the Health and Human Services Department to investigate a practice by pharmacy-benefit managers known as spread pricing, as part of a wider inquiry by lawmakers into U.S. drug costs. Ron Wyden of Oregon, the ranking Democrat on the Senate Finance Committee, said that he and Chairman Chuck Grassley of Iowa have requested the inspector general, which examines the operations of government health programs, to probe the issue. (Edney and Langreth, 4/9)

In other drug pricing news —

Stat: Alex Azar On Drug Pricing, Messaging, And Trump's Expectations
Alex Azar speaks about his efforts to lower drug prices multiple times per week with President Trump, he said Tuesday. But it is his conversations with other Republicans on that issue that have often proven more difficult, the Health and Human Services secretary acknowledged Tuesday. The conservative resistance to several key Trump administration proposals to bring down the cost of medicine is substantial enough that Azar isn’t even seeking praise from members of his own party — he counts Republicans’ tempered criticisms of the administration’s signature proposal to cap some U.S. payments for drugs as a win. (Facher, 4/10)

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