Limiting Drug Middlemen Profits in Medicare Part D for Lower Costs.
This law introduces new rules for Pharmacy Benefit Managers (PBMs) in Medicare Part D, aiming to reduce drug costs for seniors. PBM income must come solely from flat, fixed service fees, completely decoupled from drug prices, rebates, or discounts. This change is intended to increase transparency and remove hidden financial incentives that might drive up prescription drug costs for beneficiaries.
Key points
PBMs in Medicare Part D must derive income only from flat dollar service fees, not based on drug prices, discounts, or rebates received.
The goal is to eliminate incentives for middlemen to favor higher-priced drugs, potentially leading to lower prescription costs for Medicare enrollees.
Annual compliance certification and a mechanism for disgorging illegally obtained funds are mandated to ensure adherence to the new rules.
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