Bill > HR950

This bill establishes comprehensive reporting requirements for Pharmacy Benefit Managers (PBMs) operating in Medicare Part D prescription drug plans and Medicare Advantage prescription drug plans (MA-PD plans), starting in 2028. The legislation mandates that PBMs enter into written agreements with plan sponsors that require detailed annual reporting on prescription drug costs, coverage, and performance. These reports must include extensive information about drug dispensing, such as brand names, prescription claims, wholesale costs, out-of-pocket spending, manufacturer rebates, pharmacy reimbursement rates, and total revenue derived by the PBM. The bill also requires PBMs to provide transparent definitions of drug-related terms, identify pricing guarantee exclusions, and calculate cost performance measures. Additionally, the legislation includes provisions for annual audits of PBMs, allows plan sponsors to select independent auditors, and establishes enforcement mechanisms including financial penalties for non-compliance. The bill also directs the Government Accountability Office (GAO) to conduct a study on existing federal and state reporting requirements for health plans and PBMs, with the goal of potentially streamlining and reducing reporting burdens in the future.

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https://www.congress.gov/bill/119th-congress/house-bill/950/all-info