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May 12, 2023

Senate Health, Education, Labor and Pensions Committee advances four bills addressing generic drug access and PBMs

On May 11, the Senate Health, Education, Labor and Pensions (HELP) Committee resumed marking up a package of four bills aimed at increasing access to generic drugs and prohibiting certain pharmacy benefit manager (PBM) practices, such as spread pricing and pharmacy clawbacks, as well as enhancing transparency.

The markup took place after a May 2 session was cut short following concerns raised about moving forward with consideration of the bills and related amendments without first receiving cost estimates from the Congressional Budget Office (CBO) or hearing testimony from leaders of insulin manufacturers and pharmacy benefit managers at a May 10 hearing, among other concerns. At the start of the markup, HELP Committee Chair Bernie Sanders (I-VT) said that he and HELP Committee Ranking Member Bill Cassidy (R-LA) agreed in advance of the markup not to support amendments that 1) do not have a CBO score, and 2) have not received technical assistance.

The committee ultimately advanced all four measures with most of the debate and amendments focused on the Pharmacy Benefit Manager Reform Act. Committee members offered more than a dozen amendments to the bill of which eight were adopted. Much of the markup's debate centered on the bill's provision to ban spread pricing in PBM-insurer contracts, with several Republicans instead favoring guardrails on spread pricing, raising concerns that a complete ban limits plans' contracting options.

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Additional information is also available in the attached Tax Alert.


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For additional information concerning this Alert, please contact:
Washington Council Ernst & Young
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   • Heather Bell (


Bills addressing generic drug access and PBMs