Pharmacy Benefit Mgrs

Congress should (excerpted from a post): 
  • Require PBMs to provide cost disclosures and report on negotiations with drug manufacturers and profits from spread pricing and pharmacy fees to plan sponsors

  • Report annually to the FTC on spread pricing, pharmacy payments, changes to formulary tiers, and differences in reimbursements to different pharmacies  [so] policymakers and employers could better determine whether and by how much PBMs are impacting the cost of drugs and thus design evidence-based solutions

  • [With] transparency requirements ... employers could negotiate fairer contracts with PBMs to mandate transparency, limit spread pricing, and require pass-throughs.



Cantwell and Grassley (for the Committee on Commerce, Science, and Transportation), bill of May 24, 2022 (S.4293) “Pharmacy Benefit Manager Transparency Act of 2022
  • 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.
  • 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.
  • Must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies. 
  • FTC and state attorneys general are authorized to enforce the provisions of the bill

Cantwell and Grassley (for the Committee on Commerce, Science, and Transportation), bill of Jan 26, 2023 (S.127) “Pharmacy Benefit Manager Transparency Act of 2023"
Reintroduction of 2022 bill as above

No comments:

Post a Comment