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Medicare PBM Accountability Act

USA118th CongressS-2254| Senate 
| Updated: 7/12/2023
Catherine Cortez Masto

Catherine Cortez Masto

Democratic Senator

Nevada

Cosponsors (3)
Thomas Tillis (Republican)Ron Wyden (Democratic)Mike Crapo (Republican)

Finance Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Medicare PBM Accountability Act This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs. Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations. In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.
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Timeline
Jul 12, 2023
Introduced in Senate
Jul 12, 2023
Read twice and referred to the Committee on Finance.
Dec 17, 2024

Latest Companion Bill Action

HR 118-5385
Referred to the Subcommittee on Health.
  • July 12, 2023
    Introduced in Senate


  • July 12, 2023
    Read twice and referred to the Committee on Finance.


  • December 17, 2024

    Latest Companion Bill Action

    HR 118-5385
    Referred to the Subcommittee on Health.

Health

Related Bills

  • S 118-2973: Modernizing and Ensuring PBM Accountability Act
  • HR 118-5385: Medicare PBM Accountability Act
Accounting and auditingCongressional oversightContracts and agencyDrug safety, medical device, and laboratory regulationGovernment information and archivesGovernment studies and investigationsHealth care costs and insurancePrescription drugsRetail and wholesale trades

Medicare PBM Accountability Act

USA118th CongressS-2254| Senate 
| Updated: 7/12/2023
Medicare PBM Accountability Act This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs. Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations. In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
Jul 12, 2023
Introduced in Senate
Jul 12, 2023
Read twice and referred to the Committee on Finance.
Dec 17, 2024

Latest Companion Bill Action

HR 118-5385
Referred to the Subcommittee on Health.
  • July 12, 2023
    Introduced in Senate


  • July 12, 2023
    Read twice and referred to the Committee on Finance.


  • December 17, 2024

    Latest Companion Bill Action

    HR 118-5385
    Referred to the Subcommittee on Health.
Catherine Cortez Masto

Catherine Cortez Masto

Democratic Senator

Nevada

Cosponsors (3)
Thomas Tillis (Republican)Ron Wyden (Democratic)Mike Crapo (Republican)

Finance Committee

Health

Related Bills

  • S 118-2973: Modernizing and Ensuring PBM Accountability Act
  • HR 118-5385: Medicare PBM Accountability Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Accounting and auditingCongressional oversightContracts and agencyDrug safety, medical device, and laboratory regulationGovernment information and archivesGovernment studies and investigationsHealth care costs and insurancePrescription drugsRetail and wholesale trades