118th CONGRESS 2d Session |
To amend title XI of the Social Security Act to enhance pharmacy benefit manager transparency requirements.
March 19, 2024
Mr. Gallego introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To amend title XI of the Social Security Act to enhance pharmacy benefit manager transparency requirements.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. Enhancing PBM transparency requirements.
(a) In general.—Section 1150A of the Social Security Act (42 U.S.C. 1320b–23) is amended—
(1) by striking subsection (a) and inserting the following:
“(a) Provision of information.—
“(1) IN GENERAL.—The following entities shall provide the information described in subsection (b) to the Secretary and, in the case of an entity described in subparagraph (B) or an affiliate of such entity described in subparagraph (C), to the health benefits plan with which the entity is under contract, at such times, and in such form and manner, as the Secretary shall specify:
“(A) A health benefits plan.
“(B) Any entity that provides pharmacy benefits management services on behalf of a health benefits plan (in this section referred to as a ‘PBM’) that manages prescription drug coverage under a contract with—
“(i) a PDP sponsor of a prescription drug plan or an MA organization offering an MA–PD plan under part D of title XVIII; or
“(ii) a qualified health benefits plan offered through an exchange established by a State under section 1311 of the Patient Protection and Affordable Care Act.
“(C) Any affiliate of an entity described in subparagraph (B) that acts as a price negotiator or group purchaser on behalf of such PBM, PDP sponsor, MA organization, or qualified health benefits plan.
“(2) AFFILIATE DEFINED.—In this section, the term ‘affiliate’ means any entity that is owned by, controlled by, or related under a common ownership structure with a PBM (including an entity owned or controlled by the PDP sponsor of a prescription drug plan, MA organization offering an MA–PD plan, or qualified health benefits plan for which such entity is acting as a price negotiator or group purchaser).”;
(A) in paragraph (2), by inserting “and percentage” after “and the aggregate amount”; and
(B) by adding at the end the following new paragraph:
“(4) The amount (in the aggregate and disaggregated by type) of all fees the PBM or an affiliate of the PBM receives from all pharmaceutical manufacturers in connection with patient utilization under the plan, and the amount and percentage (in the aggregate and disaggregated by type) of such fees that are passed through to the plan sponsor or issuer.”; and
(3) by adding at the end the following new subsection:
“(e) Annual report.—The Secretary shall make publicly available on the Internet website of the Centers for Medicare & Medicaid Services an annual report that summarizes the trends observed with respect to data reported under subsection (b).”.
(b) Effective date.—The amendments made by this section shall apply to plan or contract years beginning on or after January 1, 2027.
(c) Implementation.—Notwithstanding any other provision of law, the Secretary may implement the amendments made by this section by program instruction or otherwise.
(d) Non-Application of the paperwork reduction act.—Chapter 35 of title 44, United States Code (commonly referred to as the “Paperwork Reduction Act of 1995”), shall not apply to the implementation of the amendments made by this section.