Pharmacy Benefit Manager Accountability Study Act of 2021
Bill: H.R.1829 | Sponsor: Rep. Harshbarger, Diana (R-TN)
Policy area: Health

Summary:
Pharmacy Benefit Manager Accountability Study Act of 2021
This bill requires the Government Accountability Office to report on the role of pharmacy benefit managers in the pharmaceutical supply chain and recommend legislative actions to lower the cost of prescription drugs. The report must address the use of rebates and fees, the average prior authorization approval time, and the use of step therapy within the 10 largest pharmacy benefit managers.

To require the Government Accountability Office to study the role 
pharmaceutical benefit managers play in the pharmaceutical supply chain 
 and provide Congress with appropriate policy recommendations, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Pharmacy Benefit Manager 
Accountability Study Act of 2021''.

SEC. 2. GAO STUDY.

    Not later than 1 year after the date of enactment of this Act, the 
Comptroller General of the United States shall submit to the Committee 
on Ways and Means, the Committee on Energy and Commerce, and the 
Committee on Education and Labor of the House of Representatives and to 
the Committee on Finance and the Committee on Health, Education, Labor, 
and Pensions of the Senate a report that--
            (1) addresses, at minimum--
                    (A) the role that pharmacy benefit managers play in 
                the pharmaceutical supply chain;
                    (B) the state of competition among pharmacy benefit 
                managers, including the market share for the Nation's 
                10 largest pharmacy benefit managers;
                    (C) the use of rebates and fees by pharmacy benefit 
                managers, including data for each of the 10 largest 
                pharmacy benefit managers that reflects, for each drug 
                in the formulary of each such pharmacy benefit 
                manager--
                            (i) the amount of the rebate passed on to 
                        patients;
                            (ii) the amount of the rebate passed on to 
                        payors;
                            (iii) the amount of the rebate kept by the 
                        pharmacy benefit manager; and
                            (iv) the role of fees charged by the 
                        pharmacy benefit manager;
                    (D) whether pharmacy benefit managers structure 
                their formularies in favor of high-rebate prescription 
                drugs over lower-cost, lower-rebate alternatives;
                    (E) the average prior authorization approval time 
                for each of the 10 largest pharmacy benefit managers;
                    (F) factors affecting the use of step therapy in 
                each of the 10 largest pharmacy benefit managers; and
                    (G) the extent to which the price that pharmacy 
                benefit managers charge payors, such as the Medicare 
                program under title XXVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.), State Medicaid programs under 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.), the Federal Employees Health Benefits Program 
                under chapter 89 of title 5, United States Code, or 
                private payors, for a drug is more than such pharmacy 
                benefit managers pay the pharmacy for the drug; and
            (2) provides recommendations for legislative action to 
        lower the cost of prescription drugs for consumers and payors, 
        improve the efficiency of the pharmaceutical supply chain by 
        lowering intermediary costs, improve competition in pharmacy 
        benefit management, and provide transparency in pharmacy 
        benefit management.
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