Pharmacy Benefit Manager Sunshine and Accountability Act

Pharmacy Benefit Manager Sunshine and Accountability Act

This bill expands and otherwise modifies reporting requirements for pharmacy benefit managers (PBMs).

Current law requires PBMs that contract with plans under the Medicare prescription drug benefit or plans that are offered on state health insurance exchanges to report certain information regarding rebates, fees, and other related information. The bill applies these requirements to PBMs that contract with private health insurers, and it expands these requirements to include more specific information relating to prices and fees, such as rebates that the PBM receives from drug manufacturers that are not passed through to other entities and the highest and lowest rebate percentages the PBM receives among all its contracts.

The bill also requires the Department of Health and Human Services to annually post the information reported by PBMs on its website.

Bill 118 HR 2816, also known as the Pharmacy Benefit Manager Sunshine and Accountability Act, aims to increase transparency and accountability in the pharmaceutical industry by regulating Pharmacy Benefit Managers (PBMs). PBMs are third-party administrators that manage prescription drug benefits for health insurance plans.

The bill requires PBMs to disclose information about their financial relationships with drug manufacturers, pharmacies, and health plans. This includes disclosing any rebates, discounts, or other financial incentives they receive from these entities. PBMs must also provide information on the prices they negotiate for prescription drugs and any fees they charge to pharmacies.

Additionally, the bill requires PBMs to report data on the drugs they cover, including information on utilization, cost, and patient outcomes. This data will be used to evaluate the effectiveness of PBMs in managing prescription drug benefits and to identify any potential conflicts of interest. Overall, the Pharmacy Benefit Manager Sunshine and Accountability Act aims to increase transparency in the pharmaceutical industry and ensure that PBMs are acting in the best interests of patients and payers. By requiring PBMs to disclose their financial relationships and report data on drug coverage, the bill seeks to hold PBMs accountable for their actions and promote greater transparency in the prescription drug market.