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Patients Before Middlemen Act
3/25/2025, 3:49 PM
Summary of Bill S 882
Under this bill, PBMs would be required to meet certain standards in order to participate in Medicare Part D. These standards would include ensuring that beneficiaries have access to a network of pharmacies that offer competitive pricing and convenient locations. PBMs would also be required to provide transparent information about drug pricing and coverage to beneficiaries.
The goal of the Pharmacy Access Improvement Act is to increase competition among pharmacies and PBMs, ultimately leading to lower costs and better access to prescription drugs for Medicare beneficiaries. This bill is currently being considered by Congress and has the potential to have a significant impact on the way prescription drug benefits are managed under Medicare Part D.
Congressional Summary of S 882
Patients Before Middlemen Act
This bill establishes certain standards and reporting requirements for prescription drug plan (PDP) sponsors, pharmacy benefit managers (PBMs), and pharmacies under the Medicare prescription drug benefit and Medicare Advantage.
Specifically, the Centers for Medicare & Medicaid Services (CMS) must develop reasonable and relevant standards for contracts between PDP sponsors and pharmacies. The CMS must seek input from interested stakeholders when developing these standards. PDP sponsors are subject to civil penalties for violating these standards; PBMs must reimburse PDP sponsors for civil penalties that result from their responsibilities.
The bill also requires the CMS to report periodically on essential retail pharmacies (i.e., pharmacies that serve as the only pharmacy within a certain radius) with respect to costs, contracts, and other specified information, particularly in relation to other types of pharmacies.
Additionally, PBMs may not receive any income other than flat, bona fide service fees. PBMs must turn over any excess amounts they receive to PDP sponsors; PDP sponsors must turn over these amounts to the CMS. In addition, PBMs must report to PDP sponsors and to the CMS 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 these requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.
The bill's changes generally apply beginning in 2028.
