PBM Accountability Project Statement on CMS Transparency in Coverage Rule and Forthcoming Prescription Drug Pricing Framework

The Centers for Medicare and Medicaid Services (CMS) this week released a finalized rule aimed at making health plan pricing information more usable, reliable and accessible. The administration is simultaneously developing a PBM transparency rule for prescription drugs in accordance with Executive Order 14273. Mark Blum, managing director of the PBM Accountability Project, issued the following statement:

“This finalized rule marks a meaningful step toward a healthcare system where patients, employers and families can understand what they are being charged and why. The PBM Accountability Project applauds the administration for moving forward with these Transparency in Coverage improvements.

“There’s still much more work to be done – and we look forward to a final rule regarding PBM fee disclosure. We urge the administration to recognize that the rules must be built to address the vertical integration and opaque inter-affiliate arrangements that have allowed the largest PBMs to extract value from the system while evading accountability.

“For too long, America’s largest insurance conglomerates have hidden behind opaque pricing structures intentionally concealing their pricing in a way that is so deliberately difficult to understand that transparency in name has delivered opacity in practice. The largest health insurers have systematically absorbed entities across the care delivery chain all while presenting a single face to the employers and workers they nominally serve.

“The public agrees that the era of healthcare opacity must end. There is strong, bipartisan demand for a system that works for patients, not against them. Today’s rule is the beginning. Future efforts will decide whether transparency becomes a genuine tool for accountability or another layer of complexity for conglomerates to continue to exploit. We stand ready to work with CMS, DOL and every partner committed to making that accountability real.”