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Pharmacy Benefit Manager Transparency Act of 2023
3/14/2024, 11:22 AM
Summary of Bill S 127
The bill requires PBMs to disclose certain information related to their operations, including the amount of rebates they receive from drug manufacturers, the discounts they negotiate with pharmacies, and the fees they charge to health plans. This information must be reported to the Department of Health and Human Services (HHS) on an annual basis.
Additionally, the bill prohibits PBMs from engaging in certain anti-competitive practices, such as steering patients to certain pharmacies or drug manufacturers in exchange for kickbacks. It also requires PBMs to pass on any rebates or discounts they receive to health plans, in order to lower prescription drug costs for consumers. Overall, the Pharmacy Benefit Manager Transparency Act of 2023 aims to increase transparency and competition in the pharmaceutical industry, ultimately leading to lower prescription drug costs for consumers. The bill has received bipartisan support in Congress and is currently under review in the Senate Health, Education, Labor, and Pensions Committee.
Congressional Summary of S 127
Pharmacy Benefit Manager Transparency Act of 2023
This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.
The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.
PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.
Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.
The FTC and state attorneys general are authorized to enforce the provisions of the bill.
