DRUG Act Delinking Revenue from Unfair Gouging Act
Impact
Should the bill be enacted, its impact would resonate through federal healthcare regulations, especially concerning contracts between PBMs and insurance carriers. The enforcement mechanisms established would empower federal agencies, including the Secretary of Health and Human Services, to impose civil penalties on PBMs that do not comply with the new rules. Additionally, any violations by PBMs would be subject to civil monetary penalties, aimed at fostering compliance and reducing possible abuses associated with the management of prescription drug benefits.
Summary
House Bill 6283, known as the Delinking Revenue from Unfair Gouging Act or the DRUG Act, aims to enhance the services provided by pharmacy benefit managers (PBMs) while addressing practices that may negatively impact patients and healthcare costs. The bill introduces regulations that prohibit PBMs from receiving remuneration for prescription drug-related services except through bona fide service fees set by agreement, which must be flat amounts and not contingent on prescription drug pricing or other variables. This approach is designed to improve transparency in the pricing of prescription drugs and associated healthcare services.
Contention
Notably, Bill HB6283 has sparked discussions around the balance of power between PBMs and pharmacies, particularly concerning practices such as 'steering'. The bill ensures that PBMs cannot unfairly promote pharmacies that they own or are affiliated with, thereby encouraging more competitive practices while mitigating potential conflicts of interest. The tension lies in defining what constitutes reasonable fees and acceptable business practices, raising concerns from some stakeholders who fear that stringent regulations might inadvertently lead to the consolidation of PBM power rather than promoting consumer choice and cost savings.
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