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.”
