Medicare PBM Accountability Act
The bill has the potential to significantly alter the operational landscape for pharmacy benefit managers by enforcing stricter reporting protocols. This could lead to better-informed beneficiaries, allowing them to understand the costs associated with their prescriptions and the financial dynamics between PBMs and drug manufacturers. Moreover, by mandating annual transparency reports from PBMs, the legislation aims to highlight discrepancies in drug pricing and encourage competitive pricing practices, ultimately benefiting Medicare beneficiaries and taxpayers.
House Bill 5385, known as the Medicare PBM Accountability Act, is aimed at enhancing transparency and accountability among pharmacy benefit managers (PBMs) operating under Medicare Part D. The bill seeks to impose specific reporting requirements on PBMs regarding the costs and rebates associated with prescription drugs. Starting in 2026, PBMs will be required to disclose detailed information including pricing guarantees, cost performance evaluations, and total out-of-pocket costs for plan enrollees, fostering a more transparent drug pricing environment.
Notably, the bill has raised discussions around the balance of transparency versus operational confidentiality for PBMs. Advocates argue that increased transparency will drive down drug costs and improve patient access to necessary medications. However, opponents express concerns over the potential administrative burden this could place on PBMs, which might limit their operational flexibility and effectiveness. Additionally, there are discussions about how to ensure that the information disclosed does not compromise sensitive business practices while still meeting the transparency goals outlined in the bill.