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Senate Finance Dives Deeper Into PBM Weeds, Including Brand Over Generic Preferences

 
• By Sarah Karlin-Smith

New draft legislation does not include proposal to force PBMs to cover and put generics and biosimilars on lower cost-sharing tiers than their more expensive branded counterparts.

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The Senate Finance Committee wants PBM justification of brand vs. generic, biosimilar tiering preferences. • Source: Shutterstock

The Senate Finance Committee's pharmacy benefits management (PBM) reform legislation would document the frequency and cost of health plans favoring higher-priced brand medicines over their generic and biosimilar equivalents in Medicare.

The new transparency requirements may help prevent plans from favoring higher list price products to capture more rebates at the expense of higher costs to patients and taxpayers. If the transparency shame factor doesn’t change behavior it could set the stage for follow-up legislation or regulation to tackle the problem. (Also see "PBM Impact On Off-Patent Industry Condemned At Senate Hearing" - Generics Bulletin, 19 April, 2023

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