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Medicare PBM Accountability Act
1/6/2025, 11:41 PM
Summary of Bill HR 5385
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.
Congressional Summary of HR 5385
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.
