DC Roundtable: Patrick Cooney of The Federal Group Drops the Latest on PBM Legislation in Washington

Congress has been debating and discussing pharmacy benefit manager (PBM) legislation for more than a year. At least three Senate committees have considered PBM bills, and the leaders of the Senate Finance Committee released a letter last month vowing to enact “meaningful pharmacy benefit manager (PBM) reforms this Congress." The House passed a sweeping healthcare bill in December 2023 by a wide bipartisan margin that included provisions affecting PBMs.

Patrick Cooney doesn’t think the senators and representatives are going to let all that work and momentum on PBM legislation go to waste.

“I do believe that at the end of the day, whether it’s the summer or during a lame-duck session we are going to see something on the president’s desk,” said Cooney, president of The Federal Group, during this episode of Managed Healthcare Executive’s "DC Roundtable” podcast.

The Federal Group is a lobbying and advocacy firm that has a number of healthcare igroups as clients, including the American College of Nurse-Midwives, the Medical Device Manufacturers Association and the Emergency Care Research Institute. Cooney is also a consultant to the Pharmacy Benefit Management Institute (PBMI), which is owned by MJH Life Sciences, the parent company that owns Managed Healthcare Executive.

Cooney © The Federal Group

During the "DC Roundtable" podcast, Cooney also said he expects any agreed-upon legislation to be fairly broad, not just limited to Medicare and Medicaid beneficiaries, and that ERISA plans are likely to affected. (ERISA stands for the Employee Retirement Income Security Act, and ERISA plans are health insurance plans established by employers who self insure). He also expects to see the provisions that address spread pricing by PBMs and increased reporting requirements.

“PBMs can expect more requirements to report information and some restrictions on actual practices,” Cooney said.

But Cooney also said that that “there is some level of understanding that we can’t completely micromanage this industry. I mean there are huge benefits to be had by having PBMs do the work they do."