Mandatory transparency for drug costs: Oversight of Pharmacy Benefit Managers (PBMs).
This Act aims to increase transparency in the healthcare system by requiring health plans and Pharmacy Benefit Managers (PBMs) to annually report detailed data on drug costs, rebates, and patient spending. This ensures that plan sponsors (like employers) and regulatory bodies receive a full picture of how prescription drug money is spent, potentially leading to better price negotiations and lower costs for citizens. The law also introduces significant financial penalties for concealing information or providing false data.
Key points
Mandatory Reporting: Health plans and PBMs must annually disclose detailed drug cost information to plan sponsors, including wholesale acquisition cost, total gross and net spending, and all rebates and fees received from drug manufacturers.
Patient Spending Transparency: Reports must include the total out-of-pocket spending by plan participants (copayments, coinsurance, and deductibles) for each drug, as well as information on manufacturer-funded copayment assistance.
Prohibition on Restrictive Contracts: PBMs are prohibited from entering into contracts with manufacturers or other third parties that limit the disclosure of this critical financial information to plan sponsors.
Penalties for Non-Compliance: Significant civil monetary penalties are established for failure to provide timely information ($10,000 per day) or for knowingly providing false information (up to $100,000 per item).
GAO Study on PBM-Owned Pharmacies: The Act mandates a Government Accountability Office (GAO) study on pharmacy networks, particularly those owned by PBMs or insurers, to assess whether these relationships influence drug pricing and patient choices.
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