Sec. 210. Public disclosure of drug discounts and other pharmacy benefit manager (PBM) provisions

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Section 1150A of the Social Security Act ( 42 U.S.C. 1320b–23 ) is amended— in subsection (c), in the matter preceding paragraph (1), by striking this section and inserting subsection (b)(1) ; and by adding at the end the following new subsection: Subject to paragraphs

(2)and (3), in order to allow patients and employers to compare PBMs’ ability to negotiate rebates, discounts, and price concessions and the amount of such rebates, discounts, and price concessions that are passed through to plan sponsors, not later than July 1, 2025, the Secretary shall make available on the Internet website of the Department of Health and Human Services the information provided to the Secretary and described in paragraphs

(2)and

(3)of subsection

(b)with respect to each PBM. The information made available in a plan year under paragraph

(1)shall not include information with respect to such plan year or the two preceding plan years. The Secretary shall ensure that such information is displayed in a manner that prevents the disclosure of information on rebates, discounts, and price concessions with respect to an individual drug or an individual PDP sponsor, MA organization, or qualified health benefits plan. . The amendment made by paragraph (1)(A) shall take effect on January 1, 2025. Section 1860D–2(d)(3) of the Social Security Act ( 42 U.S.C. 1395w–102(d)(3) ) is amended— by striking and inserting the following: Audits .—To protect Audits .— To protect ; and by adding at the end the following new subparagraph: Beginning January 1, 2025, in order to ensure that— contracting terms between a PDP sponsor offering a prescription drug plan or an MA organization offering an MA–PD plan and its contracted or owned pharmacy benefit manager are met; and the PDP sponsor and MA organization can account for the cost of each covered part D drug net of all direct and indirect remuneration, the PDP sponsor or MA organization shall conduct financial audits. An audit described in clause

(i)shall— be conducted by an independent third party; and account and reconcile flows of funds that determine the net cost of covered part D drugs, including direct and indirect remuneration from drug manufacturers and pharmacies or provided to pharmacies. A PDP sponsor and an MA organization shall require pharmacy benefit managers to make rebate contracts with drug manufacturers made on their behalf available under audits described in clause (i). Audits described in clause

(i)shall be subject to confidentiality agreements to prevent, except as required under clause (vii), the redisclosure of data transmitted under the audit. A financial audit under clause

(i)shall be conducted periodically (but in no case less frequently than once every 2 years). A PDP sponsor and an MA organization shall require that a pharmacy benefit manager that is being audited under clause

(i)provide (as part of their contracting agreement) the requested information to the independent third party conducting the audit within 45 days of the date of the request. A PDP sponsor and an MA organization shall submit to the Secretary the final report on any audit conducted under clause

(i)within 30 days of the PDP sponsor or MA organization receiving the report from the independent third party conducting the audit. The Secretary shall review final reports submitted under clause

(i)to determine the extent to which the goals specified in subclauses

(I)and

(II)of subparagraph (B)(i) are met. Notwithstanding any other provision of law, information disclosed in a report submitted under clause

(i)related to the net cost of a covered part D drug is confidential and shall not be disclosed by the Secretary or a Medicare contractor. A PDP sponsor and an MA organization shall notify the Secretary if any pharmacy benefit manager is not complying with requests for access to information required under an audit under clause (i). Subject to subclause (II), if the Secretary determines that a PDP sponsor or an MA organization has failed to conduct an audit under clause (i), the Secretary may impose a civil monetary penalty of not more than $10,000 for each day of such noncompliance. The provisions of section 1128A, other than subsections

(a)and

(b)and the first sentence of subsection (c)(1) of such section, shall apply to civil monetary penalties under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A. . Section 1860D–2(d)(2) of the Social Security Act ( 42 U.S.C. 1395w–102(d)(2) ) is amended— by striking and inserting the following: Disclosure .—A PDP sponsor Disclosure.— A PDP sponsor ; and by adding at the end the following new subparagraph: For plan year 2025 and subsequent plan years, a PDP sponsor offering a prescription drug plan and an MA organization offering an MA–PD plan shall report any pharmacy price concession or incentive payment that occurs with respect to a pharmacy after payment for covered part D drugs at the point-of-sale, including by an intermediary organization with which a PDP sponsor or MA organization has contracted, to the pharmacy. The reporting of price concessions and incentive payments to a pharmacy under clause

(i)shall be made on a periodic basis (but in no case less frequently than annually). The reporting of price concessions and incentive payments to a pharmacy under clause

(i)shall be at the claim level or approximated at the claim level if the price concession or incentive payment was applied at a level other than at the claim level. . Section 1860D–4(b)(3)(A) of the Social Security Act ( 42 U.S.C. 1395w–104(b)(3)(A) ) is amended by adding at the end the following new clause: With respect to plan year 2025 and subsequent plan years, a PDP sponsor of a prescription drug plan and an MA organization offering an MA–PD plan shall, as part of its bid submission under section 1860D–11(b), provide the Secretary with a completed statement of financial conflicts of interest, including with manufacturers, from each member of any pharmacy and therapeutic committee used by the sponsor or organization pursuant to this paragraph. . Section 1860D–11(b)(2) of the Social Security Act ( 42 U.S.C. 1395w–111(b)(2) ) is amended— by redesignating subparagraph

(F)as subparagraph (G); and by inserting after subparagraph

(E)the following new subparagraph: The information required to be disclosed under section 1860D–4(b)(3)(A)(iii). . Section 1860D–11(b) of the Social Security Act ( 42 U.S.C. 1395w–111(b) ) is amended— in paragraph (1), by adding at the end the following new sentence: With respect to actual amounts of direct and indirect remuneration submitted pursuant to clause

(v)of paragraph (2), such amounts shall be consistent with data reported to the Secretary in a prior year. ; and in paragraph (2)(C)— in clause (iii), by striking and at the end; in clause (iv), by striking the period at the end and inserting the following: , and, with respect to plan year 2025 and subsequent plan years, actual and projected administrative expenses assumed in the bid, categorized by the type of such expense, including actual and projected price concessions retained by a pharmacy benefit manager; and ; and by adding at the end the following new clause: with respect to plan year 2025 and subsequent plan years, actual and projected direct and indirect remuneration, categorized as received from each of the following: A pharmacy. A manufacturer. A pharmacy benefit manager. Other entities, as determined by the Secretary. .

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6 references not yet in our index

42 USC 1320b–23
42 USC 1395w–102(d)(3)
42 USC 1395w–102(d)(2)
42 USC 1395w–104(b)(3)(A)
42 USC 1395w–111(b)(2)
42 USC 1395w–111(b)

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cites case law

Sec. 210

Public disclosure of drug discounts and other pharmacy benefit manager (PBM) provisions

Cite42 USC 1320b–23

Cite42 USC 1395w–102(d)(3)

Cite42 USC 1395w–102(d)(2)

Cite42 USC 1395w–104(b)(3)(A)

Cite42 USC 1395w–111(b)(2)

Cites 6 · showing 5Cited by 0 across 0 sources