Sec. 4. Transparency

569 words·~3 min read·/bill/117/s/4293/rs/section-4

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Not later than 1 year after the date of enactment of this Act, and annually thereafter, each pharmacy benefit manager (or affiliate, subsidiary, or agent of a pharmacy benefit manager) shall report to the Commission the following information: The aggregate amount of the difference between the amount the pharmacy benefit manager was paid by each health plan and the amount that the pharmacy benefit manager paid each pharmacy on behalf of the health plan for prescription drugs. The aggregate amount of any— generic effective rate fee charged to each pharmacy; direct and indirect remuneration fee charged or other price concession to each pharmacy; and payment rescinded or otherwise clawed back from a reimbursement made to each pharmacy.

If, during the reporting year, the pharmacy benefit manager moved or reassigned a prescription drug to a formulary tier that has a higher cost, higher copayment, higher coinsurance, or higher deductible to a consumer, or a lower reimbursement to a pharmacy, an explanation of the reason why the drug was moved or reassigned from 1 tier to another, including whether the move or reassignment was determined or requested by a prescription drug manufacturer or other entity. With respect to any pharmacy benefit manager that owns, controls, or is affiliated with a pharmacy, a report regarding any difference in reimbursement rates or practices, direct and indirect remuneration fees or other price concessions, and clawbacks between a pharmacy that is owned, controlled, or affiliated with the pharmacy benefit manager and any other pharmacy.

Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Commission shall submit to the Committee on Commerce, Science, and Transportation of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that addresses, at a minimum— the number actions brought by the Commission during the reporting year to enforce this Act and the outcome of each such enforcement action; the number of open investigations or inquiries into potential violations of this Act as of the time the report is submitted; the number and nature of complaints received by the Commission relating to an allegation of a violation of this Act during the reporting year; an anonymized summary of the reports filed with the Commission pursuant to subsection

(a)for the reporting year; and policy or legislative recommendations to strengthen any enforcement action relating to a violation of this Act, including recommendations to include additional prohibited conducted in section 2(a). Not later than 1 year after the date of enactment of this Act, the Commission shall submit to the Committee on Commerce, Science, and Transportation of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that addresses the policies, practices, and role of pharmacy benefit managers (including their affiliates, subsidiaries, and agents) regarding formulary design or placement, including whether— pharmacy benefit managers (including their affiliates, subsidiaries, and agents) use formulary design or placement to increase their gross revenue without an accompanying increase in patient access or decrease in patient cost; or such policies or practices of pharmacy benefit managers regarding formulary design or placement violate section 5(a) of the Federal Trade Commission Act ( 45 U.S.C. 45(a) ). Nothing in this section shall be construed as authorizing the Commission to disclose any information that is a trade secret or confidential information described in section 552(b)(4) of title 5, United States Code.

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45 USC 45(a)

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Sec. 4

Transparency

Cite45 USC 45(a)

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