Chairman Wyden Calls for Increased CMS Oversight of PBMs 

On June 24, Senate Finance Committee Chairman Ron Wyden (D-OR) sent a letter to CMS urging the agency to take additional actions in its oversight and enforcement of Medicare Part D program requirements for PBMs. Wyden wrote that by evading such requirements, PBMs are “straining the finances of pharmacies and directly contributing to their closures.” The letter outlines several actions CMS could immediately take to enforce these rules, including:

• Enforcing “Any Willing Pharmacy” requirements by requiring PBMs to reimburse pharmacies at a minimum of the cost to acquire and dispense covered prescription drugs.
• Enforcing, such as through auditing, the pharmacy price concessions provision included in the 2023 Medicare Policy and Technical Changes final rule that requires all pharmacy price concessions be applied to negotiated prices at the point of sale under Part D.
• Implementing standardized pharmacy measures, including the evaluation and reporting of plan performance measures which CMS has finalized in rulemaking.
• Providing information to the Committee, within 60 days, on the number of formal or informal complaints received about PBM contracting practices over the past 18 months, a description of the type of complaints received, and the disposition of the complaints.