Protecting Medicare Patients: New Rules for Drug Benefit Managers
This act introduces new rules for Pharmacy Benefit Managers (PBMs) within the Medicare program to ensure patients pay fair prices for medications. It aims to increase transparency in drug costs and prevent unfair practices, potentially leading to lower out-of-pocket drug expenses for Medicare beneficiaries.
Key points
Pharmacy Benefit Managers (PBMs) can only earn income from flat service fees, not from drug prices or rebates.
PBMs cannot charge Medicare plans more for drugs than they reimburse pharmacies.
PBMs cannot reimburse independent pharmacies less than their own affiliated pharmacies for the same drugs.
Increased transparency: PBMs must disclose how much of the rebates from drug manufacturers they keep versus pass on to Medicare plans.
Rebate information will be publicly published, but without revealing specific plan data or individual drug prices.
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