Drug Price Transparency: Banning Unfair Practices by Pharmacy Benefit Managers
This Act aims to increase transparency in the Pharmacy Benefit Manager (PBM) industry. It prohibits unfair pricing practices, such as retaining the difference between the amount charged to a health plan and the amount reimbursed to a pharmacy, unless the PBM passes along 100% of rebates and price concessions to the payer. The law mandates full disclosure of costs, prices, and fees, and establishes strong protections for whistleblowers reporting violations.
Key points
Ban on Spread Pricing: PBMs cannot charge health plans more for a drug than they pay the pharmacy, unless they pass 100% of price concessions (rebates/discounts) back to the plan.
Full Cost Disclosure: PBMs must provide complete transparency regarding the cost, price, reimbursement, and all fees/discounts to health plans and pharmacies.
Protection for Pharmacies: Prohibits arbitrary or deceptive reduction or clawback of reimbursement payments to pharmacies, except in cases of fraud, contract inconsistency, or services not rendered.
Whistleblower Safeguards: Provides robust protection for employees reporting potential violations of the Act, including reinstatement and double back pay for adverse actions.
Expired
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