0
Protecting Patients Against PBM Abuses Act
1/6/2025, 11:41 PM
Summary of Bill HR 2880
The bill seeks to increase transparency and accountability in the PBM industry by requiring PBMs to disclose information about their pricing practices, rebates, and discounts. This information would help patients and policymakers better understand how PBMs are affecting drug prices and access to medications.
Additionally, the bill includes provisions to protect patients from unfair practices by PBMs, such as steering patients to certain pharmacies or drugs based on financial incentives. It also aims to prevent PBMs from engaging in anti-competitive behavior that could harm patients or limit their choices. Overall, the Protecting Patients Against PBM Abuses Act is designed to ensure that patients have access to affordable medications and are not unfairly impacted by the actions of PBMs. It seeks to promote transparency, competition, and fairness in the prescription drug market.
Congressional Summary of HR 2880
Protecting Patients Against PBM Abuses Act
This bill establishes requirements for Medicare pharmacy benefit managers (PBMs) with respect to remuneration, payments, and fees.
Specifically, the bill restricts PBMs that are under contract with plans under the Medicare prescription drug benefit or Medicare Advantage from (1) receiving income for their services other than flat dollar amount service fees; (2) basing any service fees on the prices of covered drugs or any associated discounts, rebates, or other remuneration; (3) charging plan sponsors for ingredient costs or dispensing fees in amounts that are different than what is reimbursed to the pharmacy; or (4) reimbursing network pharmacies for less than that what is reimbursed to PBM-affiliated pharmacies.
Such PBMs must also report on the difference between certain costs for drugs on the plan's formulary and those that are not on the formulary but are therapeutically equivalent. PBMs must also report certain information regarding rebates and fees they receive from drug manufacturers; the Centers for Medicare & Medicaid Services must publish this and other information that is currently reported by PBMs online.
