PBM Compensation 'Delinked' From List Price, Utilization In Medicare Part D Under Senate Bill

Legislation focuses on key aspect of Senate Finance Committee framework for reforming pharmacy benefit managers, reflecting concerns that current compensation practices reward PBMs for higher list prices and increase costs for patients. It does not take direct aim at rebates.

Why Are PBM Fees Based On A Drug's List Price? • Source: Shutterstock

Pharmacy benefit managers would be prohibited from accepting compensation based on the price or utilization of a drug as a condition of entering into a contract with a Medicare Part D plan, under a bill announced by the Senate Finance Committee on 14 June.

Separating compensation from price and utilization aims to address concerns that current practices encourage higher list prices and disadvantage patients...

Read the full article – start your free trial today!

Join thousands of industry professionals who rely on Pink Sheet for daily insights

  • Start your 7-day free trial
  • Explore trusted news, analysis, and insights
  • Access comprehensive global coverage
  • Enjoy instant access – no credit card required

More from Market Access

China Unveils Multiple Policies To Support Innovative Drugs Throughout Life Cycle

 
• By 

China has announced a raft of new measures to encourage innovative drug development across the product life cycle, including using insurance data to differentiate new therapies and applying commercial insurance to selected novel products.

Medicaid Changes Could Have Major Impact on Recent Coverage Improvements

 
• By 

Insurance trade groups warned that the Big Beautiful Bill destabilize Medicaid and result in the largest ever roll-back in health care coverage in the US.

England’s NHS Plan Eyes Cancer Vaccine Boost, Single Formulary & ‘Pay For Impact’ Drug Deal

 

The creation of a single national formulary for medicines prescribing that could impact industry is among the action points in the UK government’s new 10-year health plan for the National Health Service in England.

Here At Last: Canada’s Long-Contested Guidelines For Curbing Excessive Drug Prices

 

Final guidelines explaining how staff at Canada’s Patented Medicine Prices Review Board should go about identifying drugs that could be considered for an excessive price hearing will come into force soon.

More from Pink Sheet

EMA’s PRIME Scheme Explored: Growing Designations - But Are Accelerated Assessments Slipping?

 

While the first six months of the year saw eight new drugs targeting a range of diseases enter the European Medicines Agency’s priority medicines scheme, and three PRIME-designated treatments go on to win EU marketing approval, use of the accelerated assessment mechanism appears to be limited.

Global Pharma Guidance Tracker - June 2025

 

Stay up to date on regulatory guidelines from around the world with the Pink Sheet’s Guidance Tracker. The complete Global Pharma Guidance Tracker, with sortable and searchable listings going back to 2014, is available online.

US FDA’s CRL Release More Incremental Than ‘Radical’ Transparency

 

The transparency initiative collects CRLs already made public in approval packages on its drugs@fda site to post on the openFDA public portal.