PBM Legislation: Medicare Rebate Reform May Be Challenging Amid Disruption From Redesign

 
• By Cathy Kelly
  
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US lawmakers will undoubtedly continue to work on pharmacy benefit manager reform legislation in 2025, given its bipartisan support. But policies impacting rebates that could lead to higher premiums in Part D may be a tough sell in the midst of the benefit redesign.

What will happen to the PBM market in 2025? (Shutterstock)

US lawmakers will undoubtedly continue to work on pharmacy benefit manager reform legislation in 2025, given its bipartisan support. But policies impacting rebates that could lead to higher premiums in Part D may be a tough sell in the midst of the benefit redesign.

Key Takeaways

  • Bipartisan legislation introduced recently in the House would require that PBMs pass through the majority of rebates to Medicare beneficiaries at the point of sale to lower cost sharing.

The policy would essentially pass through the majority of rebates at the point of sale, a long-sought pharma priority.

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