Sec. 4. Transparency
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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to each pharmacy; direct and indirect remuneration fee charged or other price concession to each pharmacy; and payment rescinded or otherwise clawed back from a reimbursement made to each pharmacy.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 of 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 conduct 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 ( 15 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. Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Commerce, Science, and Transportation, the Committee on Finance, and the Committee on Health, Education, Labor, and Pensions of the Senate and to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report that— addresses, at minimum— the role that pharmacy benefit managers play in the pharmaceutical supply chain; the state of competition among pharmacy benefit managers, including the market share for the Nation's 10 largest pharmacy benefit managers; the use of rebates and fees by pharmacy benefit managers, including data for each of the 10 largest pharmacy benefit managers that reflects, for each drug in the formulary of each such pharmacy benefit manager— the amount of the rebate passed on to patients; the amount of the rebate passed on to payors; the amount of the rebate kept by the pharmacy benefit manager; and the role of fees charged by the pharmacy benefit manager; whether pharmacy benefit managers structure their formularies in favor of high-rebate prescription drugs over lower-cost, lower-rebate alternatives; the average prior authorization approval time for each of the 10 largest pharmacy benefit managers; factors affecting the use of step therapy in each of the 10 largest pharmacy benefit managers; and the extent to which the price that pharmacy benefit managers charge payors, such as the Medicare program under title XXVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), State Medicaid programs under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code, or private payors, for a drug is more than such pharmacy benefit managers pay the pharmacy for the drug; and provides recommendations for legislative action to lower the cost of prescription drugs for consumers and payors, improve the efficiency of the pharmaceutical supply chain by lowering intermediary costs, improve competition in pharmacy benefit management, and provide transparency in pharmacy benefit management.
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