If enacted, SB2406 will introduce significant changes to how drug formularies are managed under Medicare Part D. By requiring PDP sponsors to report on the involvement of various committees, including pharmacy benefit managers, the legislation aims to reduce conflicts of interest and enhance accountability. The bill represents a shift towards more stringent regulatory oversight, potentially impacting drug pricing strategies and formulary decisions significantly, which could, in turn, affect beneficiaries' access to certain medications under Medicare.
Summary
Senate Bill 2406, known as the PBM Oversight Act of 2023, aims to amend the Social Security Act to enhance oversight concerning pharmacy benefit managers (PBMs) and the development and management of formularies under Medicare Part D. The bill mandates that Prescription Drug Plan (PDP) sponsors submit detailed reports on any committees or individuals with decision-making authority over drug coverage, formularies, and utilization management. This transparency requirement is designed to ensure that stakeholders are aware of any potential conflicts of interest in the formulary development process.
Contention
The introduction of SB2406 has sparked debate among legislators, health advocates, and industry stakeholders. Proponents argue that enhanced oversight is necessary to mitigate the varying practices of PBMs that can limit patient access to affordable medications. In contrast, opponents express concerns that the added regulations could create bureaucratic hurdles for PBMs and may lead to increased costs for Medicare beneficiaries. The discussions around this bill underscore the ongoing tension between the need for regulatory oversight and the operational flexibility of pharmacy benefit managers.
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.
Formulary Committee members with a potential conflict of interest participation in committee communications and discussions authorization provision, public comment process for recommendations to the Formulary Committee development by the commissioner of human services requirement provision, and Minnesota Rare Disease Advisory Council expertise sought by the Formulary Committee requirement provision