On May 24th, U.S. Senators Maria Cantwell (D-WA), Chair of the Senate Committee on Commerce, Science, and Transportation, and Chuck Grassley (R-IA), Ranking Member of the Senate Judiciary Committee, introduced the Pharmacy Benefit Manager Transparency Act of 2022, which would empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold PBMs in both commercial and government sponsored/funded plans accountable for “unfair and deceptive practices that drive up the costs of prescription drugs at the expense of consumers.”
Dr. Holly Whitcomb Henry, a former president of both the National Community Pharmacists Association (NCPA) and the Washington State Pharmacy Association, and Ted Okon, CEO of the Community Oncology Alliance (COA), were quoted as supporting the bill in the Commerce Committee’s press release. (Here is NCPA’s press release and letter of support, and COA’s public statement).
We anticipate that pharmacies and their stakeholder groups will widely support the bill, which is designed to accomplish the following:
The Pharmacy Benefit Manager Transparency Act of 2022:
- Prohibits Arbitrary, Unfair or Deceptive Practices. Prohibits PBMs from engaging in spread pricing, arbitrarily, unfairly or deceptively reducing or clawing back drug reimbursement payments to pharmacies, and unfairly charging pharmacies more to offset federal reimbursement changes.
- Incentivizes Fair and Transparent PBM Practices. Provides exceptions to liability for PBMs that pass along 100% of rebates to health plans or payers and fully disclose prescription drug rebates, costs, prices, reimbursements, fees, and other information to health plans, payers, pharmacies, and federal agencies.
- Improves Transparency and Competition. Requires PBMs to report the amount of money they obtain from spread pricing, pharmacy fees, and clawbacks; any differences in the PBMs’ reimbursement rates or fees PBMs charge affiliated pharmacies and non-affiliated pharmacies; and whether and why they move drugs in formulary tiers to increase costs. Directs the FTC to report to Congress its enforcement activities and whether PBMs engage in unfair or deceptive formulary design or placement.
- Protects Whistleblowers. Protects whistleblowers from being fired or reprimanded for bringing violations to light and ensures employers cannot force employees to waive such protections with pre-dispute arbitration agreements as a condition of employment.
- Enhances Enforcement. Authorizes the FTC and state attorneys general to enforce the Act.
Text of the legislation is available HERE. Section-by-section HERE.
Please send any questions or comments to Tony Lee, Director of Public Policy, at firstname.lastname@example.org.