PBM reform in the December 2024 continuing resolution

Yes, Virginia, there is a Santa Claus. 🎅🏽

Congress is including some real PBM reform in the 1,547 page Continuing Resolution that must pass this week to keep the government running.

Here’s some of the employer plan highlights:

💯 PBM Rebates Fully Passed Through
Pharmacy Benefit Managers (PBMs) must remit 100% of rebates, fees, and discounts directly to the plan.
(Lower costs for employers and employees.)

💸 Stricter Transparency in Drug Costs
PBMs and plans will report:
• Gross vs. net prescription spending
• Itemized rebates, discounts, and fees
• Out-of-pocket costs for plan participants
(Sunshine is the best disenfectant.)

🧾Accountability Through Audits
Group health plans will be able to audit PBM practices to ensure rebate pass-through compliance.
(A win for fairness and accountability.)

But what do we need to watch for?
• The bill hasn’t passed yet, so they could pull the ball away like Lucy did to Charlie Brown and disappoint us all.
• Will PBMs adjust pricing elsewhere to offset these changes?

For now, it’s a step in the right direction. Once it passes, employers should start exploring how to leverage these measures for smarter, more cost-effective healthcare strategies.

What do you think?
Are these reforms enough to deliver real relief for employer-sponsored health plans?

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