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At least 15 House Democrats would like to keep any company that sells services to an employer-sponsored health plan from paying referral fees to the employer's broker or advisor.
Lawmakers made that clear Thursday at a bill consideration meeting, or "markup" meeting, held by the House Education and Workforce Committee.
One of the bills under consideration was the PBM Kickback Prohibition Act bill, which was introduced by Rep. Rick Allen, R-Ga.
The bill would prohibit a pharmacy benefit manager from paying referral fees or related forms of compensation to any broker, consultant, advisor or related entity.
Members of the committee ended up voting 34-0 to support the bill.
But Republican supporters of the bill first had to fend off an effort by Rep Mark DeSaulnier, D-Calif., to apply the ban on referral fees to all health plan service providers.
"By only focusing on payments made by PBMs to brokers and consultants — which is a good step — the bill ignores the vast range of other middlemen who may also engage in similar practices," DeSaulnier said during the meeting. "There is nothing in the bill that would address, for example, insurance companies or third-party administrators that might want to influence brokers and consultants by providing them with similar payments."
Allen objected to the amendment without opposing DeSaulnier's reasoning.
"Other entities may also be making steering payments to brokers and consultants," Allen said. "However, to address PBM's pharmaceutical monopoly, we keep the scope of this bill focused on PBMs."
Committee members rejected the DeSaulnier amendment by a 15-19 vote.
All Democrats who voted supported the amendment, and all Republicans who voted opposed it.
The committee held the meeting in Washington, streamed video of the meeting live and posted a recording on the web.
What it means: The current battles in Washington over how PBMs operate could affect how many other types of health plan service providers operate.
Legislative mechanics: The PBM Kickback Act bill has had support from the ERISA Industry Committee, a group for employers with large, multi-state benefit plans.
The House Education and Workforce Committee is the only committee with jurisdiction over the bill, according to the bill's Congress.gov tracking page, and the committee vote appears to clear the way for the bill to have a chance to reach the House floor.
The PBM legislation backdrop: A new federal law requires PBMs to give employers detailed reports about their operations. The new law requires employers to use the reports to manage benefits costs carefully. Supporters of the provision say it should squeeze out any strategies that cause problems.
West Virginia insurance regulators have published reports indicating that a rebate pass-through requirement there has helped to hold down insurance premium increases.
A Democrat called for the same requirements to be applied to all benefit plan service providers.
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