Pharmacy Benefit Manager Transparency Act of 2022

Bill: 117-s-4293
Sponsor: Sen. Cantwell, Maria [D-WA]
Introduced: 2022-05-24 in the Senate
Policy area: Health
Subjects: Civil actions and liability
Congressional oversight
Government information and archives
Government studies and investigations
Health care costs and insurance
Medical ethics
Prescription drugs
State and local government operations

Summary:
action_date: 2022-05-24
text: 

Pharmacy Benefit Manager Transparency Act of 2022

 
This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy. 
 
The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.
 
PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.
 
Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.
 
The FTC and state attorneys general are authorized to enforce the provisions of the bill.

action_date: 2022-12-14
text: 

Pharmacy Benefit Manager Transparency Act of 2022

 
This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy. 
 
The bill also prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans.
 
PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.
 
Further, PBMs must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.
 
The FTC and state attorneys general are authorized to enforce the provisions of the bill.


Legislative actions:
action_date: 2022-12-14
text: Placed on Senate Legislative Calendar under General Orders. Calendar No. 647.
action_date: 2022-12-14
text: Committee on Commerce, Science, and Transportation. Reported by Senator Cantwell with an amendment in the nature of a substitute. Without written report.
action_date: 2022-12-14
text: Committee on Commerce, Science, and Transportation. Reported by Senator Cantwell with an amendment in the nature of a substitute. Without written report.
action_date: 2022-06-22
text: Committee on Commerce, Science, and Transportation. Ordered to be reported with an amendment in the nature of a substitute favorably.
action_date: 2022-05-24
text: Read twice and referred to the Committee on Commerce, Science, and Transportation.
action_date: 2022-05-24
text: Introduced in Senate