Ensuring PBM Competition Act

Bill: 118-hr-6844
Sponsor: full_name: Rep. Tenney, Claudia [R-NY-24]
Introduced: 2023-12-15
Policy area: Health
Subjects: Health care costs and insurance

Prescription drugs
Latest action: action_date: 2024-12-17
text: Referred to the Subcommittee on Health.

Summaries:

tv_txt: I 118th CONGRESS 1st Session H. R. 6844 IN THE HOUSE OF REPRESENTATIVES December 15, 2023 Ms. Tenney 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 A BILL To amend title XVIII of the Social Security Act to prohibit the Secretary of Health and Human Services from entering into contracts with PDP sponsors of prescription drug plans that have a contract with certain pharmacy benefits managers.

1. Short title This Act may be cited as the Ensuring PBM Competition Act . 2. Prohibiting the Secretary of Health and Human Services from entering into contracts with PDP sponsors of prescription drug plans that have a contract with certain pharmacy benefits managers Section 1860D–12(b) of the Social Security Act ( 42 U.S.C. 1395w–112(b) ) is amended by adding at the end the following new paragraph: (9) Prohibition on entering into contracts with PDP sponsors that have a contract with a certain pharmacy benefits managers (A) In general Subject to subparagraph (B), beginning on the date that is 5 years after the date of enactment of this paragraph, the Secretary shall not enter into, or renew, a contract with a PDP sponsor for the offering of a prescription drug plan in a PDP region for a year if such sponsor has a contract for such year with a pharmacy benefits manager that, directly or indirectly, or through one or more intermediaries, owns, controls, or otherwise has a financial interest in, a pharmacy. (B) Authority to delay requirement The Secretary may delay the requirement in subparagraph (A) by not more than 2 years. (C) Pharmacy benefits manager defined For purposes of this paragraph, the term pharmacy benefits manager means any entity (or any affiliate, subsidiary, or agent of such entity) that, pursuant to an agreement with a PDP sponsor, either directly or through an intermediary acts as a price negotiator or group purchaser on behalf of such sponsor, or manages the prescription drug benefits provided by such sponsor, including the processing and paying claims for covered part D drugs, performing drug utilization review, processing drug prior authorization requests, adjudicating appeals or grievances related to covered part D drugs, contracting with network pharmacies, controlling the cost of such drugs, or providing any services related to managing such drug benefits. .