House Republicans are reportedly expected to pass President Donald Trump's spending bill today after holding a marathon voting session during the night.
All are watching to see what remains in the final version of the "Big Beautiful Bill" before it heads to Trump's desk for his signature to meet a self-imposed July 4 deadline.
A pharmacy benefit manager provision that was in the original House bill was removed from the Senate version when the bill narrowly passed on Tuesday.
The policy would have prevented PBMs from having their compensation linked to the list prices of medications, according to Seeking Alpha.
Specifically, it banned spread pricing, a practice in which a PBMs charge a health plan more for a prescription drug than it pays the pharmacy, pocketing the difference.
The provision would have implemented pass-through pricing, a model in which PBMs would reimburse pharmacies for the drug's ingredient cost plus a professional dispensing fee.
WHY THIS MATTERS
The National Community Pharmacists Association (NCPA) said in May, after the House passed the provision in its bill, that this change to Medicaid managed care payment was one of its top priorities.
The pass-through payments would be based on the National Average Drug Acquisition Cost (NADAC) plus the state's Medicaid fee-for-service professional dispensing fee, the NCPA said.
It would limit PBM payments to administrative fees.
"These provisions mirror policies already adopted in several state Medicaid managed care programs and essentially reflect the Medicaid fee-for-service rate. It saves taxpayers nearly $3 billion," NCPA said.
No one from the association could immediately be reached for comment on Thursday.
THE LARGER TREND
PBM reform, to change the way drugs are distributed in this country, has long been an issue before Congress and individual states.
In Iowa this week, a federal judge temporarily blocked a new law from taking effect that would have put restrictions on PBMs, according to KCCI.
The major PBMs are Optum Rx, owned by UnitedHealth Group; CVS Caremark, owned by CVS Health; and Express Scripts, which is part of Cigna.
Email the writer: SMorse@himss.org