Pharmacy Benefit Manager Reform Act

Pharmacy Benefit Manager Reform Act

This bill establishes various 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 net spending by the health plan on prescription drugs. PBMs also must provide plan sponsors with a supplementary report every six months with specified information about drugs that were dispensed under the plan by pharmacies that are wholly or partially owned by the PBM.

Second, the bill prohibits spread pricing. Under the bill, spread pricing occurs when a PBM charges an insurance plan (or an insurance plan charges plan participants) a price for a prescription drug that exceeds the price paid to the pharmacy for the drug.

Finally, PBMs must remit to the plan sponsor all rebates, fees, alternative discounts, and other remuneration received from a drug manufacturer.

The bill establishes civil penalties for violations of these requirements and provides funding for the Centers for Medicare & Medicaid Services and the Department of Labor to implement the provisions of this bill.

Bill 118 s 1339, also known as the Pharmacy Benefit Manager Reform Act, aims to address issues related to pharmacy benefit managers (PBMs) in the United States. PBMs are third-party administrators that manage prescription drug benefits for health insurance plans.

The bill seeks to increase transparency and accountability within the PBM industry by requiring PBMs to disclose certain information related to their operations. This includes disclosing the amount of rebates and discounts they receive from drug manufacturers, as well as the amount of fees they charge to pharmacies.

Additionally, the bill aims to address concerns about the impact of PBMs on drug pricing by prohibiting PBMs from engaging in certain practices that may lead to higher drug prices for consumers. This includes prohibiting PBMs from engaging in spread pricing, where they charge health plans more for a drug than they reimburse pharmacies for dispensing it. Overall, the Pharmacy Benefit Manager Reform Act seeks to promote greater transparency and fairness in the PBM industry in order to ensure that consumers have access to affordable prescription drugs. The bill has received bipartisan support in Congress and is currently being considered for passage.