340B ACCESS Act 340B Affording Care for Communities and Ensuring a Strong Safety-net Act
Impact
The legislation is set to affect state laws by preemptively establishing federal standards that override any existing state regulations that may conflict with the specifics of the 340B drug pricing framework. The requirements established by this bill may fundamentally change how covered entities operate, particularly in regards to patient eligibility for discounts and requirements for financial reporting. It mandates the establishment of a claims data clearinghouse, and noncompliance could result in civil monetary penalties, which introduces a significant regulatory enforcement aspect into the 340B program that did not previously exist. This may compel covered entities, particularly hospitals, to adapt their operations extensively to meet new federal standards.
Summary
House Bill 5256, known as the '340B ACCESS Act', aims to amend the Public Health Service Act to reform the existing 340B drug pricing program. The bill's primary objective is to enhance the transparency and oversight of the program by establishing clearer guidelines for covered entities and ensuring patient access to affordable medications. It outlines the responsibilities of healthcare providers who participate in the 340B program, particularly concerning compliance with discount requirements and the prohibition of duplicate discounts on drugs purchased under the program. Additionally, it seeks to implement measures that aid in identifying, billing, and avoiding duplicate billing practices, which have been concerns in the administration of the program.
Contention
While proponents argue that the bill would significantly enhance accessibility and reduce drug costs for vulnerable populations by enforcing stricter compliance and transparency measures, critics are concerned about the burden it may impose on smaller healthcare providers who might struggle to comply with the added regulatory requirements. Additionally, the requirement for transparency could lead to pushback from entities currently benefiting from the ambiguities within the system. There is also concern over how the financial penalties may disproportionately affect smaller hospitals or clinics, which could result in fewer providers participating in the program, thereby impacting access to affordable medications for the intended populations.
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.