Congress is about to implement an overhaul of pharmacy benefit managers in an effort to control drug costs, but lawmakers could be considering even more controls on drug pricing.
One of the policies left out of the current funding agreement would have banned spread pricing in Medicaid, a practice where PBMs charge health plans more than the cost of the drug and keep the “spread,” or that leftover profit.
PBM reform has been on Congress’ agenda for years, and came close to passage in December 2024 after lawmakers and staff spent weeks crafting a bipartisan health care package. That ...