Bill > HR5385

This bill, the Medicare PBM Accountability Act, would amend the Social Security Act to establish new reporting requirements for pharmacy benefit managers (PBMs) that manage prescription drug plans and Medicare Advantage prescription drug plans under Medicare Part D. The key provisions include: 1. PBMs must have written agreements with Part D plan sponsors to provide transparency around how they calculate and evaluate performance against pricing guarantees or cost measurements related to rebates, discounts, and net costs. 2. PBMs must submit annual reports to Part D plan sponsors and the Secretary of Health and Human Services providing detailed information on drug prices, utilization, costs, rebates, and other financial arrangements, which the plan sponsors must then certify to the Secretary. 3. Part D plan sponsors have the right to audit their PBM's compliance with these requirements at least annually. 4. The bill also requires a GAO study and report on federal and state reporting requirements for health plans and PBMs related to prescription drug cost transparency, with recommendations to streamline and reduce the compliance burden.

Business and Industry, Health and Social Services

https://www.congress.gov/bill/118th-congress/house-bill/5385/all-info