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S. 3345: PBM Price Transparency and Accountability Act

The PBM Price Transparency and Accountability Act is designed to address various issues related to pharmacy benefit managers (PBMs) and their interactions with pharmacies, particularly in Medicaid and Medicare programs. Key components of the bill include:

Payment Accuracy

The bill aims to improve payment accuracy for pharmacies participating in the Medicaid program. It seeks to eliminate abusive practices such as spread pricing, which can lead to pharmacies receiving lower reimbursements than they should. By enhancing payment accuracy, the legislation intends to ensure that pharmacies are fairly compensated for the medications they provide.

Beneficiary Access

Another significant goal of the bill is to ensure that Medicare beneficiaries have access to necessary pharmacy services. This could help alleviate issues where beneficiaries face barriers in obtaining medications, thereby improving their healthcare outcomes.

Accountability for Pharmacy Benefit Managers

The legislation proposes to strengthen accountability for PBMs. This includes:

Establishing restrictions on the activities of PBMs
Implementing transparency requirements so that processes related to drug pricing and reimbursement are clearer
Mandating biennial reporting on the activities of PBMs to track compliance and effectiveness of the regulations

Funding and Oversight

To support these initiatives, the bill allocates substantial funding aimed at oversight efforts and comprehensive studies. These studies will evaluate compensation structures related to drug pricing to ensure they are fair and justifiable.

Implementation Timeline

The restrictions, transparency requirements, and reporting obligations set forth in the bill are set to take effect from January 2028.

Surveys and Non-compliance Penalties

To further enhance the understanding and management of drug acquisition costs, the bill includes provisions for conducting surveys. Additionally, it establishes penalties for PBMs that do not comply with the new requirements, reinforcing the bill's aim for higher accountability and transparency in the pharmaceutical supply chain.