Increased Transparency for Drug Costs and PBMs in Medicare Part D.
This Act mandates detailed annual reporting by Pharmacy Benefit Managers (PBMs) operating within Medicare Part D plans, significantly increasing transparency regarding drug pricing and costs. This allows regulators and plan sponsors to track rebates, fees, and how much PBMs retain, potentially leading to better negotiations and lower out-of-pocket costs for Medicare beneficiaries. The rules also require PBMs to justify coverage decisions that favor expensive brand-name drugs over cheaper generics.
Key points
PBMs must disclose comprehensive financial data on drug prices, rebates, fees, and total patient out-of-pocket spending under Medicare Part D, starting in 2026.
Plans must justify why they cover expensive brand-name drugs more favorably than cheaper generic or biosimilar alternatives, aiming to reduce beneficiary costs.
Plan sponsors gain the right to audit PBMs annually to ensure compliance and accuracy of the reported cost information.
Expired
Citizen Poll