Industry insiders have voiced interesting skepticism in the face of what others outside the industry have described as much needed ground-breaking legislation aimed at curbing long-standing anti-competitive PBM practices.

As I noted in a recent post, policymakers have acknowledged for years that opaque PBM practices have distorted drug pricing and eroded trust across the prescription drug supply chain.

The new legislation prohibits PBMs from profiting based on the price of a drug. It establishes clear and consistent definitions for drug pricing in contracts, and requires robust reporting to plan sponsors on pricing, rebates, and spread arrangements. It also expands audit rights, strengthens transparency for employer-sponsored plans, and enhances protections for pharmacies, particularly those serving underserved communities. On the face of it, these significant reforms suggest a meaningful shift in leverage away from PBM intermediaries and toward plans, employers, pharmacies, and patients.

So, what’s behind the skepticism?