Pharmacy Benefit Manager Reform Act includes Senator Markey’s amendments to help ensure affordability of over-the-counter Naloxone and to prohibit gag clauses to improve transparency in health customer service tools

Naloxone Amendment (PDF) | Pricing Transparency Amendment (PDF)

Washington (May 11, 2023) – Senator Edward J. Markey (D-Mass.) today celebrated the bipartisan passage of the Pharmacy Benefit Manager Reform Act through the Senate Health, Education, Labor and Pensions (HELP) Committee, which includes language from his Naloxone Affordability Act to require the Government Accountability Office (GAO) to conduct a study on actions that may be taken to protect access to naloxone, medicine which can reverse a deadly opioid overdose, and to report on out-of-pocket costs and insurance coverage for naloxone. Today’s HELP Committee vote follows the Food and Drug Administration’s (FDA) landmark decision to approve naloxone, or Narcan, for over-the-counter sales.

In addition, the Pharmacy Benefit Manager Reform Act includes language from Senators Markey and Roger Marshall's (R-Kan.) Patient Right to Shop Act to prohibit gag clauses in Pharmacy Benefit Manager contracts so that patients can access customer pharmacy pricing tools to compare prices and make informed choices about their care.

The RAND Corporation reports that many uninsured, underserved people—representing 20 percent of adults living with an opioid use disorder (OUD)—are in need of life-saving opioid overdose treatment medication but cannot access naloxone due to expensive out-of-pocket costs. As recently as this month, pharmacies in the United States have begun charging as much as $98 for a two-dose box of Narcan.

“Americans struggle every day to navigate an inaccessible, unaffordable, and complex health care system,” said Senator Markey. “Our country is facing not just an opioid crisis but also an overdose crisis. The FDA took a major step forward by allowing naloxone to be sold over the counter, but if it’s too expensive, it will still be out of reach. That is unacceptable—naloxone can be the difference between life and death. Today’s vote to advance language that will help to lower the cost of naloxone and provide patients the pricing information they need to make decisions about their health care is a step in the direction of a more equitable and just health care system for all.”

Last month, Senator Markey introduced his bipartisan Naloxone Affordability Act, cosponsored in the Senate by Senators Marshall, Cory Booker (D-N.J.), and Mike Braun (R-Ind.). In March, Senators Markey and Rand Paul (R-Ky.) and Representative Donald Norcross (NJ-01) introduced their bipartisan and bicameral Modernizing Opioid Treatment Access Act to improve patients’ ability to access medication treatment for OUD by modernizing outdated rules, empowering board-certified physicians to prescribe methadone to patients, and allowing U.S. pharmacies to dispense methadone. In December 2022, Senator Markey secured his bipartisan Opioid Treatment Access Act (OTAA)—legislation to reduce wait times for patients qualifying for methadone medication treatment and expand access to methadone clinics—into the end-of-year omnibus spending package. During that same month, Senator Markey applauded the Department of Health and Human Services’ (HHS) proposed changes to remove barriers to OUD treatment, such as allowing people to take home doses of methadone medication, which are key provision included in the OTAA.