Medicare PBM Accountability Act

1/6/2025, 11:41 PM

Medicare PBM Accountability Act

This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.

Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.

In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.

The Medicare PBM Accountability Act, also known as Bill 118 hr 5385, is a piece of legislation introduced in the US Congress aimed at increasing transparency and accountability in the Medicare Part D prescription drug program.

The bill focuses on Pharmacy Benefit Managers (PBMs), which are third-party administrators that negotiate drug prices on behalf of insurance companies and Medicare Part D plans. The goal of the legislation is to address concerns about the lack of transparency in PBM practices and their impact on drug pricing and access for Medicare beneficiaries.

Key provisions of the Medicare PBM Accountability Act include requiring PBMs to disclose information about their pricing practices, rebates, and discounts they negotiate with drug manufacturers. The bill also aims to increase oversight of PBMs by the Centers for Medicare and Medicaid Services (CMS) and requires PBMs to report any conflicts of interest that may arise in their negotiations with drug manufacturers. Overall, the Medicare PBM Accountability Act seeks to improve transparency and accountability in the Medicare Part D program, with the ultimate goal of lowering drug costs for Medicare beneficiaries and ensuring they have access to affordable medications. The bill is currently under consideration in Congress and has garnered bipartisan support for its efforts to address concerns about PBM practices in the Medicare program.
Congress
118

Number
HR - 5385

Introduced on
2023-09-12

# Amendments
0

Sponsors
+5

Cosponsors
+5

Variations and Revisions

9/12/2023

Status of Legislation

Bill Introduced
Introduced to House
House to Vote
Introduced to Senate
Senate to Vote

Purpose and Summary

Medicare PBM Accountability Act

This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.

Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.

In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.

The Medicare PBM Accountability Act, also known as Bill 118 hr 5385, is a piece of legislation introduced in the US Congress aimed at increasing transparency and accountability in the Medicare Part D prescription drug program.

The bill focuses on Pharmacy Benefit Managers (PBMs), which are third-party administrators that negotiate drug prices on behalf of insurance companies and Medicare Part D plans. The goal of the legislation is to address concerns about the lack of transparency in PBM practices and their impact on drug pricing and access for Medicare beneficiaries.

Key provisions of the Medicare PBM Accountability Act include requiring PBMs to disclose information about their pricing practices, rebates, and discounts they negotiate with drug manufacturers. The bill also aims to increase oversight of PBMs by the Centers for Medicare and Medicaid Services (CMS) and requires PBMs to report any conflicts of interest that may arise in their negotiations with drug manufacturers. Overall, the Medicare PBM Accountability Act seeks to improve transparency and accountability in the Medicare Part D program, with the ultimate goal of lowering drug costs for Medicare beneficiaries and ensuring they have access to affordable medications. The bill is currently under consideration in Congress and has garnered bipartisan support for its efforts to address concerns about PBM practices in the Medicare program.
Alternative Names
Official Title as IntroducedTo amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D.

Policy Areas
Health

Potential Impact
Accounting and auditing
Congressional oversight
Contracts and agency
Drug safety, medical device, and laboratory regulation
Government information and archives
Government studies and investigations
Health care costs and insurance
Prescription drugs
Retail and wholesale trades

Comments

Recent Activity

Latest Summary8/20/2024

Medicare PBM Accountability Act

This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of pr...


Latest Action12/17/2024
Referred to the Subcommittee on Health.