Kaine, Colleagues Introduce Bipartisan Legislation to Crack Down on Pharmacy Benefit Managers’ Price Gouging

WASHINGTON, D.C. - U.S. Senator Tim Kaine (D-VA), a member of the Senate Health, Education, Labor and Pensions (HELP) Committee, and colleagues introduced the bipartisan, bicameral PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act, legislation that would establish fiduciary responsibilities for pharmacy benefit managers (PBMs)-the middlemen of drug pricing-and require PBMs to act in the best interests of employees relying on employer-sponsored health plans, while keeping plan costs low.

"Pharmacy benefit managers should be held accountable for their role in raising costs of prescription drugs," said Kaine. "This bipartisan legislation is critical to ensuring that PBMs are doing what's best for Americans who rely on lifesaving medication."

Currently, PBMs that provide drug benefits for employer health plans often get away with price-gouging because they are not legally required to put employees' interests first. The PBM Fair Act would ensure PBMs are classified as fiduciaries under law-thereby helping to curb hidden fees and end practices that drive up what employees pay for their medications.

To ensure employer-sponsored health care plans are affordable and accessible to all families, this bill would specifically rein in bad PBM practices, such as:

• Marking up generic drugs at prices hundreds of times higher than actual cost;
• Limiting patient choice; and
• Denying claims with no or misleading explanations.

In addition to Kaine, this bill is introduced by U.S. Senators Roger Marshall (R-KS), Maggie Hassan (D-NH), and Chuck Grassley (R-IA). Companion legislation is led in the House by U.S. Representatives Jake Auchincloss (D-MA-04) and Ryan Mackenzie (R-PA-07).

Full text of the bill is available here.

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