Pharmacy Benefits Manager Accountability Act

Pharmacy Benefits Manager Accountability Act

This bill establishes reporting requirements for pharmacy benefit managers (PBMs) with respect to services provided to health insurance plans.

First, PBMs must report annually to the plan sponsor certain information about the PBM's services, including the amount of prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total gross and net spending by the health plan on prescription drugs during the reporting period. PBMs also must submit specified elements of the report (e.g., the total gross spending on prescription drugs) to the Government Accountability Office (GAO). The report must comply with the privacy requirements under the Health Insurance Portability and Accountability Act of 1996.

The bill establishes civil penalties for violations of these requirements and provides for enforcement by the appropriate agencies.

GAO must report on the pharmacy networks of plans or PBMs, including whether such networks under common ownership with the plans or PBMs are designed to encourage plan enrollees to use network pharmacies over other pharmacies.

Bill 118 hr 2679, also known as the Pharmacy Benefits Manager Accountability Act, aims to increase transparency and accountability within the pharmaceutical industry by regulating Pharmacy Benefits Managers (PBMs). PBMs are third-party administrators that manage prescription drug benefits for health insurance plans.

The bill requires PBMs to disclose certain information, such as the amount of rebates they receive from drug manufacturers and the discounts they negotiate with pharmacies. This information must be reported to the Department of Health and Human Services (HHS) on a regular basis.

Additionally, the bill prohibits PBMs from engaging in certain anti-competitive practices, such as steering patients to certain pharmacies or drug manufacturers in exchange for kickbacks. It also requires PBMs to pass on any rebates or discounts they receive to the health insurance plans they work with, in order to lower prescription drug costs for consumers. Overall, the Pharmacy Benefits Manager Accountability Act seeks to increase transparency and competition in the pharmaceutical industry, ultimately leading to lower prescription drug costs for Americans.