The bill's provisions are designed to address current challenges beneficiaries face, such as limited pharmacy access and high costs associated with prescription drugs. By enforcing that contract terms with PBMs must be reasonable and relevant, it seeks to ensure that pharmacies are compensated fairly for dispensing medications, which could lead to improved patient access to necessary medications. Implementing enhanced transparency measures within pharmacy benefit management practices is intended to safeguard patient interests and provide oversight to prevent unfair practices prevalent in the industry.
Summary
SB882, known as the 'Patients Before Middlemen Act', aims to amend Title XVIII of the Social Security Act to enhance pharmacy access and choice for beneficiaries under prescription drug plans and Medicare Advantage drug plans. The bill establishes requirements for pharmacy benefit managers (PBMs) in relation to their operations under Medicare Part D, focusing on ensuring that beneficiaries have a broader selection of pharmacies and potentially lowering their out-of-pocket drug costs. The legislation mandates that any pharmacy meeting the standard contractual terms must be allowed to participate in prescription drug plans, promoting a competitive environment.
Contention
Notably, discussions around SB882 highlight a degree of contention regarding the potential backlash from pharmacy benefit managers who may resist increased regulatory scrutiny. There are concerns that while the bill aims to support patient welfare and pharmacy accessibility, it may also lead to significant operational shifts for PBMs, affecting their profit margins. The enforcement mechanisms outlined, including the establishment of accountability protocols for violations of contract terms, could result in heightened tensions between PBMs and regulators as they navigate compliance complexities over the coming years.
Related
Bipartisan Health Care Act Pandemic and All-Hazards Preparedness and Response Act SUPPORT for Patients and Communities Reauthorization Act of 2025
Related
Lower Costs for Everyday Americans Act Nationwide Consumer and Fuel Retailer Choice Act Recycling and Composting Accountability Act SUPPORT for Patients and Communities Reauthorization Act of 2025 American Music Tourism Act Deploying American Blockchains Act
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.
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.