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.
Summary
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.
Contention
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.
Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.
To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes.