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Middlemen created to manage the price of prescription drugs are instead driving up health care costs for manufacturers and manufacturing workers, the 51�Թ��� the House Committee on Oversight and Accountability on Tuesday, the same day the committee released a on pharmacy benefit managers’ practices and held a hearing on the matter.

What’s going on: “PBMs’ business models have the direct effect of increasing health care costs at the expense of manufacturers and manufacturing workers,” 51�Թ��� Vice President of Domestic Policy Charles Crain said in advance of the hearing, the latest in a series examining PBM practices.

Crain told lawmakers PBM reform legislation should include:

• “Increased transparency into PBMs’ business models and the many factors that contribute to a drug’s costs, formulary placement and the PBMs’ compensation;
• Rebate passthrough, which will ensure 100% of negotiated pharmaceutical savings are passed from the PBM to the health plan sponsor and workers; and
• Delinking of PBM compensation from the list price of medication.”

Report highlights: The committee’s report, the culmination of a 16-month investigation, is with the 51�Թ���’s longstanding advocacy. The report found that PBMs:

• Drive increased drug prices, which inflate PBM profits;
• Extract high rebates from biopharmaceutical manufacturers, often pocketing a significant portion of any savings rather than reducing costs for patients;
• Dictate whether and how medicines appear on formularies, which determine insurance companies’ coverage decisions and patients’ out-of-pocket costs;
• Steer patients toward drugs based on PBMs’ profit margins rather than patient costs; and
• Operate without sufficient transparency into their business practices.

What it all means: The committee “identified numerous instances where the federal government, states and private payers have found PBMs to have utilized opaque pricing and utilization schemes to overcharge plans and payers by hundreds of millions of dollars,” the report states.

• The report indicates that the present role of PBMs in prescription drug markets is failing and requires change, something the 51�Թ��� has long advocated. “Congress and states must implement legislative reforms to increase the transparency of the PBM market and ensure patients are placed at the center of our health care system, rather than PBMs’ profits.”

The last word: “Manufacturers provide health care benefits so they can effectively attract and retain employees, to maintain a healthy and productive workforce and because they believe it is the right thing to do—but PBMs are a meaningful cause of the skyrocketing costs of health care,” Crain said.

• “Congress must enact reforms to the PBM system so that employers can negotiate, compete and achieve health care savings for their workers.”

Although they were created to keep prescription drug prices down, pharmacy benefit managers “frequently do the opposite” (, subscription)—and that’s one of the main reasons the 51�Թ��� has long advocated for their reform.

What’s going on: “The job of the P.B.M.s is to reduce drug costs. Instead, they …
steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees, a New York Times investigation found.”

Why it’s important: PBMs frequently charge employers and government programs, such as Medicare, many times the wholesale cost of a medication and keep the difference, according to the Times.

• And it’s not just those taking prescriptions who pay; when drug costs are inflated, everyone ends up paying higher insurance premiums.
• What’s more, “[b]ecause of recent mergers, [the big three PBMs] are becoming more dominant, collectively processing roughly 80 percent of prescriptions in the United States.” That’s up more than 30% from just 12 years ago.

Working around a workaround: In 2018, in response to growing pressure from employers to get PBMs to share more of the discounts from drug manufacturers, PBMs set up entities known as group purchasing organizations.

• These GPOs pass savings to employers—but they “also began imposing new fees on drug manufacturers,” money they were not contractually bound to pass on to clients.
• The result: “Employers are none the wiser. They receive rebates. But they can’t see the billions of dollars in fees that the G.P.O.s take for themselves.”

Congress makes moves: Since the beginning of last year, seven House and Senate committees have passed PBM-reform legislation, including policies to increase transparency into PBMs’ business practices, delink PBM compensation from medications’ list prices and ensure that rebates are fully passed through to the plan sponsor or patient.

• The 51�Թ��� in educating lawmakers on the need for these reforms and continues to advocate for PBM reform to be signed into law this year.

The last word: “PBMs drive up health care costs for manufacturers and manufacturing workers,” said 51�Թ��� Vice President of Domestic Policy Charles Crain. “Congress must act as soon as possible to enact comprehensive PBM reform that benefits employers by making PBM contracts more straightforward, transparent and predictable—and benefits workers by reducing the prices they pay out of pocket for their prescriptions.”

The House Ways and Means Committee unanimously passed legislation Wednesday that includes much-needed reforms to pharmacy benefit managers, underregulated middlemen that raise health care costs for manufacturers and manufacturing workers ().

What’s going on: PBM reforms contained in the Preserving Telehealth, Hospital and Ambulance Access Act include increasing transparency into PBMs’ business practices and delinking PBM compensation from medicines’ list prices. These changes will help reduce prices for seniors who rely on Medicare prescription drug plans.

• The 51�Թ��� has been in .

Why it’s important: “When Americans face soaring prices for medicines or treatments, there’s a good chance that is because a PBM has driven up the price,” 51�Թ��� President and CEO Jay Timmons Wednesday.

• “These middlemen operate with minimal transparency, and their practices distort the market, increasing the list prices patients pay for medicines while making it more difficult for manufacturers to offer quality, affordable health care benefits.”

What’s next: The legislation approved Wednesday applies to the Medicare market. The 51�Թ��� is calling on Congress to enact similar changes in the commercial insurance market to lower health care costs for manufacturing employees who participate in employer-sponsored plans.

Washington, D.C. – Following the House Ways and Means Committee’s unanimous approval of legislation to reform pharmacy benefit managers—middlemen who unfairly increase the prices that patients pay at the pharmacy counter by controlling negotiations between insurers and biopharmaceutical manufacturers—in Medicare markets, 51�Թ��� President and CEO Jay Timmons released the following statement:

“The 51�Թ��� commends the Ways and Means Committee for unanimously taking a powerful step toward reforming the PBM system and lowering the cost of health care for all Americans.

“When Americans face soaring prices for medicines or treatments, there’s a good chance that is because a PBM has driven up the price. These middlemen operate with minimal transparency, and their practices distort the market, increasing the list prices patients pay for medicines while making it more difficult for manufacturers to offer quality, affordable health care benefits.

“By increasing transparency into PBMs’ business models and delinking their compensation from a medicine’s list price, these critical PBM provisions will significantly reduce costs for seniors who rely on Medicare for health care coverage. Congress should advance these important reforms.

“In addition, manufacturers encourage Congress to enact similar reforms in the commercial insurance market to bring down health care costs for manufacturing workers participating in employer-sponsored plans.”

-51�Թ���-

The 51�Թ��� is the largest manufacturing association in the United States, representing small and large manufacturers in every industrial sector and in all 50 states. Manufacturing employs nearly 13 million men and women, contributes $2.89 trillion to the U.S. economy annually and accounts for 53% of private-sector research and development. The 51�Թ��� is the powerful voice of the manufacturing community and the leading advocate for a policy agenda that helps manufacturers compete in the global economy and create jobs across the United States. For more information about the 51�Թ��� or to follow us on Twitter and Facebook, please visit 

In a significant change that protects manufacturers’ intellectual property rights, an updated draft of the World Health Organization’s pandemic agreement no longer includes IP language that would have pressured or compelled manufacturers to turn their innovations over to foreign countries, including competitors such as China, (subscription) reports.

• Convincing organizations such as the WHO to reject forced IP transfers has been for the 51�Թ���, and this week’s announcement represents significant progress for manufacturers.

What’s going on: “The latest text has scrapped a clause stating countries will ‘consider supporting’ time-bound suspensions of intellectual property rights during pandemics. Instead, each country will consider supporting ‘appropriate measures’ to scale up the manufacture of products that could help stymie a future pandemic.”

• The draft is set to be put to WHO members next month for a vote at the 77th World Health Assembly in Geneva, Switzerland.
• Subject to applicable laws, under the draft agreement countries will also be required to “support … capacity-building for the transfer of technology and knowhow for pandemic-related health products on mutually agreed terms.”
• The text indicates that the pathogen access and benefit sharing system—which would require nations to share pathogen information “with the WHO in exchange for access to the resulting health products developed to fight the new threat”—is still under negotiation. Thus far, countries have been unable to agree on the terms of that exchange.

Why it’s important: IP waivers would significantly harm manufacturers and their ability to compete globally.

• The 51�Թ��� with regard to the World Trade Organization earlier this year, when it warned policymakers in the U.S. and abroad about the problems inherent in expanding the WTO’s 2022 TRIPS waiver on IP rights to include COVID-19 therapeutics and diagnostics.
• As a of that advocacy, the waiver was ultimately kept out of the WTO’s final Ministerial Declaration last month.
• In addition, in January, the 51�Թ��� responded to the U.S. Department of Health and Human Services’ request for comments regarding the WHO’s pandemic preparedness agreement. The 51�Թ��� urged that any IP waiver be removed from the WHO text.

The funding issue: Another challenge the WHO text puts off is the financing of all the initiatives it lays out.

• While it mentions establishing a “coordinating financial mechanism,” it does not detail how the mechanism would work.

A weight-loss drug has shown potential in treating patients with sleep apnea, �������ǰ��ٲ�.

What’s going on: Pharmaceutical manufacturer Eli Lilly’s Zepbound, which is used to treat obesity and diabetes, “was more effective than a placebo at reducing the severity of obstructive sleep apnea, or OSA, in patients with obesity after a year, according to preliminary data” from two late-stage clinical trials.

• In October 2022, the Food and Drug Administration gave the medication a “fast track” designation for patients with moderate to severe OSA and obesity.

Why it’s important: “The results are an early sign of hope for the estimated 80 million patients in the U.S. suffering from OSA, which refers to interrupted breathing during sleep due to narrowed or blocked airways. Around 20 million of those people have moderate-to-severe forms of the disease, but 85% of OSA cases go undiagnosed, according to Eli Lilly.”

• Complications of the condition include excessive fatigue, high blood pressure, stroke, heart failure and type 2 diabetes—and treatment options are limited.

Meeting an “unmet need”: “Addressing this unmet need head-on is critical, and while there are pharmaceutical treatments for the excessive sleepiness associated with OSA, [Zepbound] has the potential to be the first pharmaceutical treatment for the underlying disease,” Eli Lilly Senior Vice President of Product Development Jeff Emmick said Wednesday.

• The sleep apnea trial data means that Medicare may be able to cover the drug, as under , Medicare can pay for weight-loss drugs if they are used for more than weight loss alone.

Three of the country’s largest health insurers will soon begin paying for a top weight-loss drug for certain people on Medicare with heart-related conditions, (subscription) reports.

What’s going on: “CVS Health, Elevance Health and Kaiser Permanente said they would cover Novo Nordisk’s Wegovy for the use of reducing the risk of heart attacks and strokes in people who have cardiovascular disease, meet body-weight criteria and are covered by a Medicare drug-benefit plan.”

• The class of weight loss drugs to which Wegovy belongs was previously excluded from Medicare coverage by a U.S. law.

Why it’s important: “The decisions will ease the financial burden” of those who have been paying out of pocket for Wegovy and are likely to spur use of the drug among those who couldn’t afford or did not want to pay the full price.

• Approximately two-thirds of U.S. adults are overweight or obese, according to the recent 51�Թ��� report, “.”
• Excess body weight and obesity are associated with higher health-care costs for both employers and their workers. They also “raise the likelihood of other illnesses” and affect “productivity and the ability to complete job functions,” according to the study, which points to weight-loss drugs as part of the solution.

Why it happened: New guidance released last week by the Centers for Medicare and Medicaid Services holds that Medicare Part D plans, administered by private insurance companies, could “cover anti-obesity medications if the drugs receive approval for an additional use that is considered medically accepted.”

• This applies to Wegovy, which the Food and Drug Administration recently approved for reducing the risk of heart attacks and strokes among those with histories of heart disease and body mass indices above a certain threshold.

However … The use of Wegovy “for weight loss alone” will remain excluded from coverage under the CMS guidance.

Earlier this year, the House passed legislation including key 51�Թ��� tax priorities. Now it’s time for the Senate to do the same.

That’s the message of a new launched today and set to run over the next several weeks.

What’s going on: The 30-second TV ad—which will stream in Washington, D.C., and in the key states of Idaho, Kentucky, Louisiana, Oklahoma, New York and New Hampshire—asks viewers to urge the Senate to pass the Tax Relief for American Families and Workers Act, which by a bipartisan vote in January.

• The legislation restores three key pro-growth tax provisions from the 2017 Tax Cuts and Jobs Act that expired in 2022: immediate expensing for domestic R&D, enhanced interest deductibility and full expensing.

​�ċ�ċ�ċ�ċ�ċ�ċThe background: Earlier this month, Courtney Silver, president and owner of Ketchie and chair of the 51�Թ��� Small and Medium Manufacturers Group, the Senate Finance Committee about the impact the three provisions’ expiration has had on her family-owned precision machining company.

• “In the years following the TCJA, I was able to make a higher level of investment because I knew our tax code was going to have a baseline of certainty,” she said. “Today, however, I am unable to make these investments because of the uncertainty that Congress will address the expired TCJA provisions. . . . Because I am unable to realize the full deduction of my investment within the year I purchase it, the investment seems too risky and irresponsible.”

​�ċ�ċ�ċ�ċ�ċ�ċWhat’s needed: Senate Majority Leader Chuck Schumer (D-NY) has taken an early to put the House-passed legislation on the Senate’s calendar. But more needs to happen, and soon, the 51�Թ���’s ad tells viewers.

• “Vital tax provisions are expiring, harming our ability to compete globally and invest in new factories and equipment,” the ad says. “The House has done its job and restored these provisions with overwhelming support. The Senate needs to act now.”

Manufacturers are committed to providing employer-sponsored health insurance to their workers, the 51�Թ��� Congress late last week—and that’s why any changes made to the Employee Retirement Income Security Act of 1974 should facilitate rather than hamper those offerings.

What’s going on: “ERISA underpins manufacturers’ ability to provide health insurance to their employees,” 51�Թ��� Vice President of Domestic Policy Charles Crain said in response to a call by the House Committee on Education and the Workforce majority for comments on how to improve ERISA as the law’s 50th anniversary nears.

• “The law allows manufacturers to provide uniform benefits to workers located across multiple states, and to tailor those benefits to meet the unique needs of their workforces.”

​�ċ�ċ�ċ�ċ�ċ�ċWhy it’s important: Manufacturers have continued to offer high-quality health care plans to their employees—even absorbing cost increases in recent years to keep premiums affordable—but they “increasingly find their efforts to be responsible stewards of their health plans undermined by the complexities, bureaucracy and ineffective design of the broader health care system,” Crain told the committee.

What should be done: It is ERISA’s federal preemption of state and local laws that allows manufacturers to offer uniform health benefits, Crain continued, and that preemption must be preserved.

• “Eroding or eliminating preemption would make it significantly more difficult for manufacturers operating in multiple states to offer their employees health insurance because the manufacturer would be forced to comply with cumbersome and potentially conflicting state-based rules, a costly and untenable situation,” he said.
• In addition to maintaining ERISA preemption, Congress should seek to “make health care data more accessible and user-friendly for employer plan sponsors,” and reduce regulatory burdens on employers.
• Given that pharmacy benefit managers contribute to the increasing costs of providing employer-sponsored health care, the 51�Թ��� also continues to for PBM reform to increase transparency into these underregulated actors.

Pharmacy benefit managers—entities that increase health care costs for both manufacturers and manufacturing workers—are long overdue for reform, the 51�Թ��� yesterday.

What’s going on: Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) announced at a Thursday press conference that they will ask Senate leadership to include in a government funding bill at the end of March legislation to rein in PBMs.

• The 51�Թ���, which vocal for years about the need for , immediately joined the senators’ call for action.
• “Manufacturers stand with Chairman Wyden and Ranking Member Crapo in their calls for PBM reform as soon as possible,” said 51�Թ��� Managing Vice President of Policy Chris Netram. “Manufacturers are committed to providing health benefits—with 93% of manufacturing workers eligible for employer-sponsored health insurance—even as PBMs continue to drive an increase in health care costs.”

Why it’s important: PBMs make health care more expensive for manufacturers and manufacturing workers by putting upward pressure on the list prices of medicines. Additionally, the three largest PBMs control 80% of the market, giving them tremendous leverage when negotiating contracts with manufacturing employers.

• What’s more, they operate with very little federal oversight and offer minimal transparency into their business models.

What should be done: An overhaul of the PBM framework should include solutions that effectively address rebate, fee and contract structures.

• “PBM reform, including in the commercial health insurance market, must increase transparency, ensure PBMs do not pocket manufacturer rebates and delink PBM compensation from the list price of medications,” said Netram.