The enactment of HB 6844 would represent a significant shift in the regulatory landscape for prescription drug plans under Medicare. By restricting the contracts between PDP sponsors and PBMs that have financial interests in pharmacies, the bill aims to enhance transparency and competition in medication pricing. Proponents argue that the measure could lead to lower drug costs for consumers and more competitive pharmacy services. However, the delay option included in the bill allows the Secretary of Health and Human Services to postpone the prohibition by up to two years, which may affect its immediate implementation.
Summary
House Bill 6844, known as the 'Ensuring PBM Competition Act,' seeks to amend title XVIII of the Social Security Act to prevent the Secretary of Health and Human Services from engaging in contracts with Prescription Drug Plan (PDP) sponsors that have agreements with certain pharmacy benefits managers (PBMs). This legislation is intended to promote competition within the pharmacy sector by limiting the influence of PBMs, which have been criticized for their role in drug pricing and access to medications. The bill outlines a specific timeframe, starting five years post-enactment, after which such contracts would be prohibited, thereby affecting future PDP agreements.
Contention
Debate surrounding HB 6844 may center on the potential consequences for the pharmaceutical supply chain and patient access to medications. Critics of the bill may highlight concerns that limiting PDP sponsors' contractual relationships with PBMs could disrupt established pharmacy networks and lead to unintended consequences for medication management. Additionally, there could be discussions about the balance of regulation versus market forces, with some arguing that this bill could stifle operational efficiencies that PBMs provide in negotiating drug prices and managing formularies.
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.