Pharmacy benefit managers (PBMs) are facing a spate of Congressional action and investigations as the nation struggles to contain rising pharmaceutical costs. A bipartisan senate committee recently passed the Pharmacy Benefit Manager Transparency Act of 2023, and the Senate Finance Committee held its own hearings on the need for PBM transparency. The senate committee bill, which hasn’t advanced to the full senate, identifies three overarching requirements that if passed must be met by PBMS.
The bill addresses
- Prohibition of unfair or deceptive drug pricing practices
This includes eliminating spread pricing, a practice whereby PBMs charge the health plan or payer more for a prescription drug than the PBM reimbursed to the pharmacy. Also, PBMs will be required to forward to a health plan 100% of any rebate, price concession or discount received from drug manufacturers.
- Prohibition on false information
A PBM will face civil penalties for submitting false or misleading information compiled by a federal department or agency for the statistical or analytical purpose related to PBM services.
- Transparency
A PBM will be required to provide an annual report to the Federal Trade Commission (FTC) disclosing the aggregate difference between how much each health plan paid the PBM for prescription drugs and the related payment to pharmacies.
The bill also addresses civil penalties PBMs could face for noncompliance under the Federal Trade Commission Act, which could be as much as $1 million per violation. Bukaty Companies will continue to monitor Congressional action addressing PBMs and drug pricing.
