Two Tester Bills to Lower Drug Costs for Montanans Pass Committee, Set up Full Senate Vote

Senator’s bills bring accountability to PBMs, protect patients and small businesses

As part of his continued push to lower costs for Montana’s working families, two of U.S. Senator Jon Tester’s bills that would lower prescription drug costs and prevent massive Pharmacy Benefit Managers (PBMs) from price gouging consumers passed through the Senate Finance Committee, setting up both bills for a full vote on the Senate floor.

Tester’s bipartisan Patients Before Middlemen Act and Pharmacy DIR Reform to Reduce Senior Drug Costs Act will protect rural pharmacies and hold massive corporations and PBMs accountable by prohibiting PBMs from making more money on high-cost drugs than they do from lower-cost drugs to lower costs for patients, and eliminating the retroactive nature of direct and indirect remuneration (DIR) clawback fees imposed by PBMs.

“Most Montanans rely on rural pharmacies to get vital medications – and the sad truth is, massive corporations are holding these folks hostage with skyrocketing drug prices and hidden fees, forcing them to choose between filling their pantry or picking up lifesaving medicines,” Tester said, “That’s why I’ve been fighting to get my bipartisan bills to lower prescription drug costs and hold PBMs accountable across the finish line. These bills passing out of committee is great news, and I’ll keep pushing until they become law so that we put an end to price gouging and hidden clawback fees once and for all.”

Tester has consistently worked across the aisle to increase access to quality and affordable health care in urban, rural, and Tribal communities in Montana and is a leading advocate in Congress to lower costs of prescription drugs. Tester’s bills that advanced out of committee are:

• The Patients Before Middlemen Act: Tester’s bipartisan Patients Before Middlemen Act lowers drug costs and prevents massive PBMs from price gouging consumers. Instead of incentivizing PBMs to buy and sell the most expensive drugs by linking their service fees to the list price of drugs, this bill would only allow PBMs to charge a flat fee for their services. Right now PBMs make less money from lower-cost drugs and they often get left off formularies and aren’t covered by insurance. This bill seeks to disrupt that incentive and lower drug costs by delinking PBM’s revenue streams from the list price of drugs.

• The Pharmacy DIR Reform to Reduce Senior Drug Costs Act: In recent years, PBMs have increasingly returned to pharmacies days or even weeks after the point-of-sale to demand more in DIR fees. From 2010 to 2019, CMS documented a 91,500 percent increase in DIR fees paid by pharmacies. Tester’s bipartisan Pharmacy DIR Reform to Reduce Senior Drug Costs Act will ensure that all pharmacy price concessions are assessed at the point of sale and eliminate the retroactive nature of direct and indirect remuneration (DIR) clawback fees imposed by PBMs. The Centers for Medicare and Medicaid Services (CMS) estimates this change will save Medicare beneficiaries an estimated $7.1 to $9.2 billion in reduced cost sharing.

Tester has led the charge to cut costs for Montana’s families and seniors. The Inflation Reduction Act requires Medicare to negotiate drug prices, caps out-of-pocket prescription drug costs for Medicare patients at $2,000/year, caps the cost of insulin for Medicare patients at $35/ month, and extends Affordable Care Act provisions to prevent price hikes for thousands of Montanans. The legislation was signed into law in August 2022 and is fully paid for by holding corporations and billionaires accountable.