WASHINGTON — Republican Sen. Chuck Grassley wants to see his party’s leadership turn up the pressure on pharmacy benefit managers.
“They talk in such generalities on this subject that it’s difficult for me to tell where they’re coming from,” he said at a STAT event Wednesday, speaking about top GOP senators’ approach to reforming the drug pricing middlemen who negotiate between pharmaceutical companies and insurers. “We’re hearing… ‘We don’t want to do something splitting the caucus.’ But we’ve got a major problem here with PBMs deciding rebates, deciding the price of drugs, probably being an instrument to drive up the price of drugs, and nobody knows what they’re doing.”
Grassley has reason to push urgency. The Senate leaves this weekend for a July recess and when they return next month, lawmakers have just over two weeks of working days in the Capitol before a monthlong August break. Multiple drug pricing priorities hang in limbo.
Several committees are cooking up different ideas on PBM reforms — the Senate health committee passed a package out of committee that included a ban on spread pricing, a requirement that PBMs pass rebates through to their plan sponsors, and transparency requirements. The Senate Finance Committee has released one bill that would address fees based on drugs’ list prices, but it’s planning to release more, as well.
Grassley has also introduced a bill with Washington Democrat Maria Cantwell that would boost the Federal Trade Commission’s oversight of PBM practices and prohibit the companies from clawing back payments or using spread pricing. PBMs that pass all the negotiated rebates through to payers would be exempt from those rules.
He told STAT during Wednesday’s Next Frontier of Drug Pricing Reform event that the two PBM reform bills, his and the HELP committee legislation, are “complementary” and can be negotiated.
Meanwhile three insulin cap bills, two of them bipartisan, are on the table. Majority Leader Chuck Schumer and top-ranking Democrats in the health committee have said the legislation would be a top priority after the debt ceiling negotiation, which lawmakers hammered out in early June.
Grassley told STAT that of the various insulin plans, he most preferred a $35 cap proposed by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine). But what he most wants to see is a package binding a widely-supported insulin cap bill with his proposed PBM reforms.
The longtime senator and highest-ranking Republican on the Finance committee likened the Republican divide on PBM reform to 2018 efforts to pass a major criminal justice overhaul. Leadership was similarly worried then about dividing the caucus, but the legislation ultimately advanced with an 87-12 vote.
“We’ve got to pass legislation. We can’t put up anymore with … middle people, between the companies and the consumer, without knowing what they’re doing, particularly when they’re raking in a lot of taxpayer money,” he said.
Rachel Cohrs contributed to this report.