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Pharmacy Benefit Manager Bills Advance in Congress

September 6, 2018

This week, both the U.S. House and Senate advanced separate bills banning pharmacy benefit managers’ (PBMs) non-disclosure or “gag clauses” on pharmacists.  Once enacted, pharmacists will be able to tell people if their medication would be cheaper without insurance.
The U.S. Senate has two bills under consideration – S. 2553 which would end PBM gag clauses in Medicare and S. 2554 in group health plans and exchanges. S. 2553 passed the full Senate on Sept. 4 and the Senate is expected to pass the S.2554 later this month.

On September 7, the U.S. House Energy and Commerce Committee approved a bill that would end gag clauses in the private health insurance market and Medicare. This is good sign the House will consider legislation soon.  Once the bills pass both chambers, a conference committee will form. The Administration has indicated support for banning PBM gag clauses.

The National MS Society supports the banning of gag clauses as they align with the Society’s Access to MS Medications Recommendations.  The Recommendations call for increased transparency throughout the pharmaceutical system and supply chain—from manufacturers, insurers and PBMs, among others. However, determining the role that pharmacy benefit managers play in prescription drug pricing and consumer access is currently difficult given the lack of information that is publicly available. 

In recent years it has become apparent that consumers may be paying more than the actual cost of their medication (the price negotiated by the PBM) at the pharmacy. Pharmacists who violated the contract with PBMs could have been penalized with fees or pulled from the network. This issue tends to affect access to symptom-management medications, which people living with MS may commonly purchase via a local pharmacy, more than disease-modifying therapies.

Learn more about access to MS medications bills moving through Congress.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.


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