Both chambers of the United States Congress are working on a top health care priority for the session—protecting patients from high out-of-pocket drug costs and pharmacy benefit manager (PBM) practices that could reduce access and adherence to treatments.
In the Senate, Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) recently introduced the Pharmacy Benefit Manager Transparency Act of 2023 (S.127), legislation that would incentivize fair and transparent PBM practices, prohibit unfair or deceptive pricing practices, and mandate transparency. The Association for Clinical Oncology (ASCO) endorses this timely legislation and will continue to work with bill sponsors to shed light on opaque PBM practices that can negatively impact individuals with cancer.
Additionally, the Senate Judiciary Committee held a hearing on bills to reform drug patents, address rising drug pricing, and increase transparency in the pharmaceutical supply chain. All of the bills advanced out of committee, including S. 79, the Interagency Patent Coordination and Improvement Act, which ASCO endorses.
In the House of Representatives, Representatives Buddy Carter (R-GA) and Nanette Diaz Barragan (D-CA) reintroduced the Help Ensure Lower Patient (HELP) Copays Act (H.R. 830), which would require health plans to count the value of copay assistance toward patient cost-sharing requirements. The bill would also close a loophole that allows many employer health plans to deem certain covered drugs “nonessential,” which means that the insurer does not count any cost-sharing for those drugs toward the patient’s deductible and out-of-pocket maximum. ASCO supports the bill’s two-tiered approach to eliminating barriers to lifesaving treatments.
ASCO will monitor the status of these bills and any future bills that address PBM practices and patient out-of-pocket costs, and the Association will work with Congress to ensure the oncology community is heard throughout the process.
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