Sec. 142. Strengthening and expanding pharmacy benefit managers transparency requirements
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Section 1150A of the Social Security Act ( 42 U.S.C. 1320b–23 ), as amended by section 123, is amended— in subsection (a)— in paragraph (1), by striking or at then end; in paragraph (2), by striking the comma at the end and inserting ; or ; and by inserting after paragraph
(2)the following new paragraph: a State plan under title XIX, including a managed care entity (as defined in section 1932(a)(1)(B)), ; in subsection (b)— in paragraph (2)— by striking (excluding bona fide and all that follows through patient education programs)) ; and by striking aggregate amount of and inserting aggregate amount and percentage of ; in paragraph (3), by striking aggregate amount of and inserting aggregate amount and percentage (defined as a share of gross drug costs) of ; and by adding at the end the following new paragraph: The aggregate amount of bona fide service fees (which include distribution service fees, inventory management fees, product stocking allowances, and fees associated with administrative services agreements and patient care programs (such as medication compliance programs and patient education programs)) the PBM received from— PDP sponsors; qualified health benefit plans; managed care entities (as defined in section 1932(a)(1)(b)); and drug manufacturers. ; in subsection (c), by adding at the end the following new paragraphs: To States to carry out their administration and oversight of the State plan under title XIX. To the Federal Trade Commission to carry out section 5(a) of the Federal Trade Commission Act ( 15 U.S.C. 45a ) and any other relevant consumer protection or antitrust authorities enforced by such Commission, including reviewing proposed mergers in the prescription drug sector. To assist the Department of Justice to carry out its antitrust authorities, including reviewing proposed mergers in the prescription drug sector. ; and by adding at the end the following new subsection: The Inspector General of the Department of Health and Human Services shall conduct an annual evaluation of the information provided to the Secretary under this section. Such evaluation shall include an analysis of— PBM rebates; administrative fees; the difference between what plans pay PBMs and what PBMs pay pharmacies; generic dispensing rates; and other areas determined appropriate by the Inspector General. Not later than July 1, 2020, and annually thereafter, the Inspector General of the Department of Health and Human Services shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate. Such report shall not disclose the identity of a specific PBM, plan, or price charged for a drug. .
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- 42 USC 1320b–23
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Sec. 142
Strengthening and expanding pharmacy benefit managers transparency requirements
Cite42 USC 1320b–23
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